经鼻高流量氧疗对早期急性心力衰竭合并Ⅱ型呼吸衰竭患者的临床疗效OA
Therapeutic effectiveness of high-flow nasal cannula oxygen therapy for early-stage acute heart failure complicated by type Ⅱ respiratory failure
目的 评估经鼻高流量氧疗(HFNC)应用于早期急性心力衰竭合并Ⅱ型呼吸衰竭患者的临床疗效.方法 纳入2021年11月—2023年11月于解放军联勤保障部队第九八〇医院住院的早期急性心力衰竭合并Ⅱ型呼吸衰竭患者共100例,采用随机数字表法分为研究组(n=44)与对照组(n=56).对照组实施无创正压通气干预,研究组则采用HFNC方案.分别于入院即刻及入院24 h后,对比观察两组的血流动力学指标[心率、呼吸频率、平均动脉压(MAP)]、心肺功能指标[N末端脑钠肽前体(NT-proBNP)、超敏肌钙蛋白(hs-cTn)、左心室射血分数(LVEF)、乳酸(Lac)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、血氧饱和度(SpO2)]及临床治疗相关指标[24 h内气管插管率、不良反应发生率、住院时间]的变化情况.结果 入院24 h后,两组心率、呼吸频率、MAP、NT-proBNP、hs-cTn、Lac及PaCO2水平均较入院时有所下降,其中研究组的心率、呼吸频率、MAP、NT-proBNP及PaCO2降幅更为显著,均低于同期对照组(P<0.05).入院24 h后,两组LVEF、PaO2及SpO2均较入院时升高,且研究组PaO2与SpO2水平高于对照组(P<0.05).两组间入院24 h后的hs-cTn、Lac及LVEF比较差异均无统计学意义(P>0.05).此外,研究组 24 h 内气管插管率与不良反应发生率均为6.82%(3/44)低于对照组的21.43%(12/56)、23.21%(13/56),住院时间亦较对照组缩短(P<0.05).结论 HFNC用于早期急性心力衰竭合并Ⅱ型呼吸衰竭患者可获得更佳的临床疗效,能够有效改善患者血流动力学状态与心肺功能,且具备良好的安全性.
Objective To evaluate the therapeutic effectiveness of high-flow nasal cannula(HFNC)oxygen therapy in individuals presenting with early-stage acute heart failure complicated by typeⅡrespiratory failure.Methods A total of 100 patients with early acute heart failure complicated by typeⅡrespiratory failure,who were hospitalized at the 980th Hospital of the Joint Logistic Support Force of the PLA between November 2021 and November 2023,were enrolled in this study.Subjects were assigned to either a study group(n=44)or a control group(n=56)via the random number table technique.The control group received non-invasive positive pressure ventilation(NIPPV),whereas the study group underwent HFNC oxygen therapy.The two groups were compared with respect to three categories of parameters:hemodynamic indices[heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)],cardiopulmonary function markers[N-terminal pro-brain natriuretic peptide(NT-proBNP),high-sensitivity cardiac troponin(hs-cTn),left ventricular ejection fraction(LVEF),lactate(Lac),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2),and oxygen saturation(SpO2)],and clinical treatment-related indicators[24-hour endotracheal intubation rate,incidence of adverse reactions,and duration of hospital stay].Results At 24 h following admission,both groups exhibited significantly lower levels of HR,RR,MAP,NT-proBNP,hs-cTn,Lac and PaCO2,among which HR,RR,MAP,NT-proBNP,and PaCO2 were much lower in the study group,as compared with the control group during the same period(P<0.05).At 24 h after admission,LVEF,PaO2 and SpO2 in both groups were higher than those before admission,and PaO2 and SpO2 were higher in the study group than in the control group(P<0.05).No significant intergroup differences were observed with regard to hs-cTn,Lac,or LVEF at 24 h after admission(P>0.05).Furthermore,both the 24-hour intubation rate and incidence of adverse reactions were 6.82%(3/44),which were lower than those of the control group[21.43%(12/56),23.21%(13/56)],and duration of hospital stay was shorter in the study group relative to controls(P<0.05).Conclusion Administration of HFNC oxygen therapy yields enhanced clinical outcomes for patients with early acute heart failure complicated by typeⅡrespiratory failure,and can effectively improve hemodynamics and cardiopulmonary function,with a favorable safety profile.
张磊;王力傲;董俊婵;阳绪华;侯云生;贾丽君;付丽娜;王梅英
解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082解放军联勤保障部队第九八〇医院第五派驻门诊部,石家庄 050082解放军联勤保障部队第九八〇医院保健科,石家庄 050082解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082解放军联勤保障部队第九八〇医院急诊医学科,石家庄 050082
经鼻高流量氧疗急性心力衰竭Ⅱ型呼吸衰竭N末端脑钠肽前体左心室射血分数血氧饱和度平均动脉压超敏肌钙蛋白
high-flow nasal cannula oxygen therapyacute heart failuretypeⅡ respiratory failureN-terminal pro-brain natriuretic peptideleft ventricular ejection fractionoxygen saturationmean arterial pressurehigh-sensitivity cardiac troponin
《临床误诊误治》 2026 (15)
62-68,7
河北省医学科学研究课题计划(20211550)
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