Application of nasal high flow oxygen in alveolar lavage in patients with pulmonary infection and type Ⅰ respiratory failure
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摘要: 目的 探讨经鼻高流量氧疗对肺炎所致Ⅰ型呼吸衰竭患者的疗效，对氧合指数在150~300 mmHg的患者行纤支镜肺泡灌洗的有效性及安全性。方法 选取常熟市第二人民医院重症医学科2018年4月—2020年12月收治的70例肺部感染伴Ⅰ型呼吸衰竭患者，随机分为2组。对照组(33例)患者在不采用机械通气氧疗的情况下，采用传统面罩给氧; 治疗组(37例)选择经鼻高流量氧疗供氧。在持续心电监护下对患者行纤维支气管镜肺泡灌洗术。监测并记录术前、术中及术后的指脉氧，术前、术后的氧分压以及术中因缺氧导致的不良反应。结果 2组间对比，治疗组与对照组术前、术后指脉氧、血气分析中的氧分压、二氧化碳分压及氧合指数比较差异无统计学意义(P>0.05)，而术中指脉氧的变化差异有统计学意义(P < 0.05)。组内对比，治疗组及对照组的术前、术后指脉氧与术中的指脉氧比较均差异有统计学意义(P < 0.05)，对照组术后二氧化碳分压高于术前(P < 0.05)，治疗组、对照组术后氧合指数均有显著改善(P < 0.05)。相对于治疗组，对照组有更多因缺氧导致的不良反应，2组比较差异有统计学意义(12.12%、0;P < 0.05)。结论 在Ⅰ型呼吸衰竭且氧合指数在150~300 mmHg的肺部感染患者中，相较于传统吸氧方式，采用经鼻高流量氧疗的方式行肺泡灌洗治疗更为安全，值得临床推广。Abstract: Objective To investigate the effectiveness and safety of applying transnasal high-flow oxygen therapy to patients with typeⅠ respiratory failure due to pneumonia and an oxygenation index of 150-300 mmHg undergoing fibrilloscopic alveolar lavage.Methods Seventy patients with pulmonary infection with typeⅠ respiratory failure admitted to the Department of Critical Care Medicine of the Second People's Hospital of Changshu from April 2018 to December 2020 were selected and randomly divided into two groups, and patients in the control group(33 cases) were administered oxygen by traditional mask without mechanical ventilation oxygen therapy. The treatment group(37 cases) was selected for oxygenation by transnasal high-flow oxygen therapy. Fiberoptic bronchoscopic alveolar lavage was performed on the patients under continuous cardiac monitoring. Pre-, intra-and postoperative finger pulse oxygen, pre-and postoperative oxygen partial pressure and intraoperative adverse effects due to hypoxia were monitored and recorded.Results In the between-group comparison, there was no statistical difference between the treatment group and the control group in the comparison of preoperative and postoperative finger pulse oxygen, partial pressure of oxygen, partial pressure of carbon dioxide and oxygenation index in blood gas analysis(P>0.05), while there was a statistical difference in the change of intraoperative finger pulse oxygen(P < 0.05). In intra-group comparison, there were significant differences in preoperative and postoperative finger pulse oxygen in the treatment and control groups compared to intraoperative finger pulse oxygen(P < 0.05), postoperative carbon dioxide partial pressure was higher than preoperative in the control group(P < 0.05), and postoperative oxygenation index was significantly improved in both the treatment and control groups(P < 0.05). The control group had more adverse effects due to hypoxia relative to the treatment group, and there was a statistically significant difference between the two groups(12.12%, 0, P < 0.05).Conclusion In patients with pulmonary infections in typeⅠ respiratory failure and an oxygen and oxygen index of 150-300 mmHg, alveolar lavage treatment with transnasal high-flow oxygen therapy is safer than conventional oxygen administration and is worthy of clinical promotion.
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表 1 2组患者一般资料的比较
例(%)，X±S 组别 例数 年龄/岁 性别 CURB-65/分 APACHEⅡ评分/分 白细胞计数(×109/L) 男 女 治疗组 37 71.86±8.95 17(45.9) 20(54.1) 1.43±0.50 13.35±2.65 12.05±4.32 对照组 33 72.30±6.71 16(48.5) 17(51.5) 1.61±0.49 12.55±3.03 15.48±5.21 F 3.26 0.71 1.79 3.26 χ2 0.05 P 0.08 0.83 0.52 0.19 0.08 
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表 2 2组患者术前、术中、术后指脉氧以及术前、术后氧合指数的比较
X±S 组别 例数 术前指脉氧/% 术中指脉氧/% 术后指脉氧/% 术前氧合指数/mmHg 术后氧合指数/mmHg 治疗组 37 96.38±1.72 94.95±2.41 96.73±1.611) 228.18±38.72 237.59±33.082) 对照组 33 96.52±1.80 92.58±3.71 97.00±1.631) 239.73±40.85 248.12±38.612) F 0.22 3.37 1.79 0.51 1.25 P 0.64 0.04 0.18 0.48 0.27 与本组术中指脉氧比较，1)P < 0.05;与本组术前氧合指数比较，2)P < 0.05。
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表 3 2组患者术前、术后氧分压、二氧化碳分压的比较
mmHg，X±S 组别 例数 术前氧分压 术后氧分压 术前二氧化碳分压 术后二氧化碳分压 治疗组 37 84.03±14.04 88.08±6.31) 47.82±8.05 49.22±7.59 对照组 33 87.88±6.24 90.55±6.041) 43.71±9.08 48.10±5.962) F 1.39 0.33 2.01 0.91 P 0.24 0.57 0.16 0.34 与本组术前氧分压比较，1)P < 0.05;与本组术前二氧化碳分压比较，2)P < 0.05。
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