经鼻高流量氧疗不同流速设置对急性低氧性呼吸衰竭患者的影响

doi:10.3761/j.issn.0254-1769.2022.15.001

摘要/Abstract

摘要：

目的探讨经鼻高流量氧疗（high flow nasal cannulae,HFNC）不同流速设置对急性低氧性呼吸衰竭患者重要生理参数、舒适度、呼吸窘迫程度的影响。方法采用便利抽样法,选取2019年9月—2020年9月重庆市某三级甲等综合医院重症医学科收治的129例急性低氧性呼吸衰竭患者作为研究对象,通过对患者实施HFNC,探究不同流速（低流速组30~ 35 L/min,中流速组40~45 L/min,高流速组50~60 L/min）对急性低氧性呼吸衰竭患者呼吸频率、心率、气管插管率、舒适度、呼吸窘迫度的影响。结果应用HFNC 6、24、48 h,低、中流速组呼吸频率均低于高流速组;应用HFNC 72 h,低流速组呼吸频率低于高流速组;应用HFNC 6、48、72 h及结束时,低流速组舒适度及呼吸窘迫度评分最低;应用HFNC 24 h,低、中流速组舒适度评分及呼吸窘迫度评分低于高流速组（均P<0.05）。通过对不同缺氧程度的急性低氧性呼吸衰竭患者进行亚组分析,氧合指数201~300 mmHg（1 mmHg=0.133 kPa）为轻度缺氧组,101~200 mmHg为中度缺氧组,低氧流速设置下,应用HFNC 6 h,中度缺氧患者呼吸频率更低;应用HFNC 48 h,中度缺氧患者呼吸窘迫程度更低;治疗结束时,中度缺氧患者心率更低。中氧流速设置下,应用HFNC 6、24、48 h时,中度缺氧患者的呼吸频率更慢;应用HFNC 48 h,中度缺氧患者心率更慢（均P<0.05）。结论 HFNC流速设定需结合患者的吸气需求、缺氧程度以及耐受性与舒适度,进行个性化、动态化管理。

关键词: 经鼻高流量氧疗, 呼吸功能不全, 流速设置, 流速调节, 重症监护

Abstract:

Objective To explore the effects of high flow nasal cannulae oxygen therapy（HFNC） with different flow rates about important physiological parameters,comfort and respiratory distress on patients with acute hypoxic respiratory failure. Methods The convenience sampling method was used to recruit 129 patients with acute hypoxic respiratory failure treated in the Intensive Care Unit of a tertiary A hospital in Chongqing from September 2019 to September 2020. Through the implementation of HFNC,the effects of different flow rates（30~35 L/min in the low flow rate group,40~45 L/min in the medium flow rate group,50~60 L/min in the high flow rate group） on respiratory rate,heart rate,endotracheal intubation rate,respiratory comfort and respiratory distress of patients with acute hypoxic respiratory failure were investigated. Results After the treatment for 6,24 and 48 h,the respiratory rate of low and medium flow rate groups was lower than that of the high flow rate group. After 72 h treatment, the respiratory rate of the low flow rate group was lower than that of the high flow rate group. The comfort and respiratory distress scores in the low flow rate group were the lowest after 6,48,72 treatment and the end of treatment. After 24 h treatment, the comfort and respiratory distress scores of low and medium flow rate groups were lower than those of the high flow rate group. According to the subgroup analysis of patients with different degrees of hypoxia（oxygenation index 201~300 mmHg is the mild hypoxia group and 101~200 mmHg is the moderate hypoxia group）,under the setting of hypoxic flow rate,the respiratory rate of moderate hypoxia subjects was lower when HFNC for 6 h. The degree of respiratory distress was lower in moderate hypoxia subjects after HFNC for 48 h;HFNC for 48 h;At the end of treatment,moderate hypoxia subjects had lower heart rate. For medium oxygen flow HFNC treatment,the respiratory rate of the moderate hypoxia group was lower than that of the mild hypoxia group at 6 h,24 h and 48 h after HFNC treatment,and the heart rate of the moderate hypoxia group at 48 h after HFNC treatment was lower（all P<0.05）. Conclusion The flow rate setting of HFNC needs to be personalized and dynamically managed in combination with the patient’s inspiratory demands,degree of hypoxia,tolerance and comfort.

Key words: High Flow Nasal Cannulae, Respiratory Insufficiency, Flow Rate Setting, Flow Rate Regulation, Intensive Care

周建珍, 张传来, 徐莉, 黄文褀, 周蝶, 杨睿琦, 杨燕慧. 经鼻高流量氧疗不同流速设置对急性低氧性呼吸衰竭患者的影响[J]. 中华护理杂志, 2022, 57(15): 1797-1803.

ZHOU Jianzhen, ZHANG Chuanlai, XU Li, HUANG Wenqi, ZHOU Die, YANG Ruiqi, YANG Yanhui. Effect of high flow oxygen therapy with different flow rates on patients with acute hypoxic respiratory failure[J]. Chinese Journal of Nursing, 2022, 57(15): 1797-1803.

图/表 4

表1 3组急性低氧性呼吸衰竭患者基线资料比较

Table 1 Comparison of baseline data of 3 groups of patients with acute hypoxic respiratory failure

表2 3组急性低氧性呼吸衰竭患者结局指标比较

Table 2 Comparison of outcome indicators of 3 groups of patients with acute hypoxic respiratory failure

表3 不同缺氧程度急性低氧性呼吸衰竭患者低流速经鼻高流量氧疗效果比较

Table 4 Comparison analysis of hypoxic flow rate HFNC in patients with acute hypoxic respiratory failure with different degrees of hypoxia

表4 不同缺氧程度急性低氧性呼吸衰竭患者中氧流速经鼻高流量氧疗氧疗效果比较

Table 4 Comparison analysis of medium flow rate HFNC in patients with acute hypoxic respiratory failure with different degrees of hypoxia

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