Effect of nasal high flow oxygen therapy in elderly patients with acute respiratory failure and analysis of prognostic risk factors
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摘要: 目的 观察经鼻高流量氧疗(HFNC)在老年急性呼吸衰竭(ARF)患者中的应用效果，并分析影响ARF患者HFNC治疗后预后不良的危险因素。方法 选择2022年1月—2022年10月广西医科大学附属武鸣医院收治的93例ARF患者作为研究对象，按随机数字表法分为2组。观察组48例采取HFNC治疗，对照组45例采取经鼻标准吸氧治疗，比较2组患者生命体征指标[心率(HR)、平均动脉压(MAP)、呼吸频率(RR)]、血气指标[动脉血氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、酸碱度(pH值)]及治疗期间并发症发生情况。观察组根据HFNC治疗预后情况，分为预后良好组、预后不良组，统计2组基线资料，分析HFNC治疗老年ARF患者预后不良的危险因素。结果 治疗后，2组HR、RR均优于治疗前，观察组优于对照组(P < 0.05)；治疗后，2组PaO2、pH值优于治疗前，PaCO2优于治疗前，观察组PaO2、pH优于对照组，PaCO2优于对照组(P < 0.05)；2组并发症发生率比较，差异无统计学意义(P>0.05)；预后不良组APACHE Ⅱ评分、治疗前BNP、HR水平高于预后良好组，舌根后坠患者占比高于预后良好组(P < 0.05)；APACHE Ⅱ评分、治疗前BNP水平、治疗前HR水平高表达，舌根后坠是老年ARF患者HFNC治疗后预后不良的危险因素(OR>1，P < 0.05)。结论 HFNC能够有效改善老年ARF患者生理指标，缓解患者缺氧状况，且安全性较高，同时患者APACHE Ⅱ评分、治疗前BNP、HR水平及舌根后坠发生情况与HFNC治疗效果密切相关。Abstract: Objective To observe the application effect of HFNC in elderly patients with acute respiratory failure(ARF) and analyze the factors affecting the poor prognosis of patients with ACRF after HFNC treatment.Methods A total of 93 patients with ARF who were admitted to Wuming Hospital Affiliated to Guangxi Medical University from January 2022 to October 2022 were selected as the research subjects and divided into two groups according to the random number table. 48 cases in the observation group were treated with HFNC, 45 cases in the control group were treated with standard nasal oxygen inhalation. The patients in both groups received continuous treatment until they were discharged from hospital or switched to other ventilation treatments. The vital sign indexes[heart rate(HR), mean arterial pressure(MAP), respiratory frequency(RR)], blood gas indexes[arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), and pH]of the patients between the two groups were compared, as well as the complications during the treatment. According to the prognosis of HFNC treatment, the observation group was divided into a good prognosis group and a poor prognosis group. The baseline data of the two groups were counted, and the risk factors for poor prognosis of elderly ACRF patients treated with HFNC were analyzed.Results After treatment, HR and RR of the two groups were better than those before treatment, and the effect of the observation group was better than that of the control group(P < 0.05). After treatment, PaO2 and pH in the two groups were better than those before treatment, PaCO2 was better than that before treatment, PaO2 and pH in the observation group were better than those in the control group, and PaCO2 was better than the control group(P < 0.05). There was no significant difference in the incidence of complications between the two groups(P>0.05). The APACHE Ⅱ score, BNP level and HR level before treatment in the poor prognosis group were higher than those in the good prognosis group, and the proportion of patients with tongue root falling back was higher than that in the good prognosis group(P < 0.05). The APACHE Ⅱ score, BNP level before treatment, high expression of HR level before treatment and falling back of the tongue root were risk factors for poor prognosis of elderly ACRF patients after HFNC treatment(OR>1, P < 0.05).Conclusion HFNC can effectively improve the physiological indexes of elderly patients with ACRF and alleviate the hypoxia in patients with high safety. Meanwhile, APACHE Ⅱ score, BNP level, HR level before treatment and the occurrence of tongue root falling are closely related to the treatment effect of HFNC.
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Key words:
- respiratory failure /
- high-flow nasal cannula oxygen therapy /
- elderly /
- prognosis /
- wallowing tongue
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表 1 基线资料比较
例，X±S 组别 对照组(n=45) 观察组(n=48) t/χ2 P 性别 0.095 0.758 男 23 23 女 22 25 病因 1.244 0.744 心源性肺水肿 8 5 支气管哮喘急性发作 24 26 急性肺栓塞 11 14 其他 2 3 COPD 0.366 0.545 是 16 20 否 29 28 病程/年 6.50±1.47 6.60±1.37 0.340 0.735 HR/(次·min-1) 114.34±12.28 113.09±14.11 0.454 0.651 MAP/mmHga) 98.37±5.16 98.06±7.52 0.230 0.819 RR/(次·min-1) 27.47±5.49 27.03±5.24 0.395 0.694 PaO2/mmHg 54.39±5.03 53.71±5.19 0.641 0.523 PaCO2/mmHg 60.03±4.17 61.25±4.29 1.389 0.168 pH 7.21±0.08 7.22±0.07 0.643 0.522 注：a)1 mmHg=0.133 kPa。 
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表 2 2组生命体征指标比较
X±S 组别 HR/(次·min-1) MAP/mmHg RR/(次·min-1) 对照组(n=45) 98.61±8.03 98.19±6.81 21.03±4.52 观察组(n=48) 82.24±9.57 98.03±7.67 16.27±3.39 t 8.905 0.106 5.769 P < 0.001 0.916 < 0.001
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表 3 2组血气指标比较
X±S 组别 PaO2/mmHg PaCO2/mmHg pH 对照组(n=45) 60.28±4.28 56.17±4.03 7.33±0.05 观察组(n=48) 73.03±6.14 51.84±3.96 7.38±0.04 t 11.545 5.225 5.341 P < 0.001 < 0.001 < 0.001
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表 4 2组并发症发生情况比较
例(%) 组别 胃胀气 误吸 口咽干燥 总并发症 对照组(n=45) 1(2.22) 0 3(6.67) 4(8.89) 观察组(n=48) 2(4.17) 1(2.08) 3(6.25) 6(12.50) χ2 0.051 P 0.821
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表 5 HFNC治疗的呼吸衰竭组不同预后老年ARF患者基线资料比较
例(%)，X±S 资料 预后不良组(n=11) 预后良好组(n=37) χ2/t P 性别 0.227 0.634 男 6(54.55) 15(40.54) 女 5(45.45) 22(59.46) 年龄/岁 66.75±2.74 65.08±3.67 1.394 0.170 体重指数/(kg/m2) 24.08±2.64 23.74±2.17 0.434 0.666 ARF类型 0.159 0.691 Ⅰ型 9(81.82) 34(91.89) Ⅱ型 2(18.18) 3(8.11) 气管插管史 0.148 0.700 有 3(27.27) 6(16.22) 无 8(72.73) 31(83.78) APACHE Ⅱ评分/分 19.29±3.66 16.13±4.47 2.136 0.038 治疗前BNP水平/(ng·L-1) 180.37±34.79 139.38±29.84 3.852 ＜0.001 治疗前HR水平/(次·min-1) 119.97±5.17 112.52±4.67 4.535 ＜0.001 病因 1.914 0.590 心源性肺水肿 2(18.18) 4(10.81) 支气管哮喘急性发作 7(63.64) 19(51.35) 急性肺栓塞 2(18.18) 11(29.73) 其他 0 3(8.11) 舌根后坠 4.600 0.032 有 5(45.45) 4(10.81) 无 6(54.55) 33(89.19) 高血压 1.327 0.249 有 6(54.55) 11(29.73) 无 5(45.45) 26(70.27) 糖尿病 ＜0.001 1.000 有 2(18.18) 6(16.22) 无 9(81.82) 31(83.78) 吸烟 0.162 0.687 有 4(36.36) 9(24.32) 无 7(63.64) 28(75.68) 饮酒 0.071 0.790 有 5(45.45) 13(35.14) 无 6(54.55) 24(64.86)
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表 6 赋值说明
影响因素 变量类型 赋值说明 APACHE Ⅱ评分 连续变量 - 治疗前BNP水平 连续变量 - 治疗前HR水平 连续变量 - 舌根后坠 分类变量 “0”=无，“1”=有
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表 7 各因素与老年ACRF患者HFNC治疗预后的关系
影响因素 B SE Wald P OR 95%置信区间 APACHE Ⅱ评分 6.386 13.237 0.233 < 0.001 3.750 1.124~14.367 治疗前BNP水平 2.472 0.937 0.254 0.014 1.604 1.037~7.246 治疗前HR水平 4.041 8.476 0.227 < 0.001 6.887 2.361~11.859 舌根后坠 25.333 8.476 0.161 < 0.001 11.205 3.107~24.948 常量 -69.124 13.190 0.232 < 0.001
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