呼吸湿化治疗仪在Ⅰ型呼吸衰竭患者中的应用
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摘要
目的:探讨呼吸湿化治疗仪治疗呼吸衰竭患者的临床效果。方法:选取钦州市妇幼保健院、红十字医院ICU和呼吸科诊断为Ⅰ型呼吸衰竭患者102例,随机分为呼吸治疗仪组51例,无创呼吸机组51例。两组患者均采用常规治疗,呼吸治疗仪组患者加用呼吸湿化治疗仪治疗,无创呼吸机组加用无创呼吸机治疗。比较两组患者临床疗效,治疗后1 d血气指标,治疗时间接受情况,治疗失败需插管例数、鼻咽喉疼痛及胃肠胀气例数及死亡例数。结果:呼吸湿化治疗仪组治疗有效率高于无创呼吸机组,差异有统计学意义(P<0.05);治疗1 d后,两组患者氧分压高于治疗前,二氧化碳分压低于治疗前,差异均有统计学意义(P<0.05),两组pH值与治疗前比较差异无统计学意义(P>0.05),治疗1 d后两组间氧分压和二氧化碳分压比较,差异无统计学意义(P>0.05);呼吸湿化治疗仪组患者总时间(长时间+短时间)及长时间接受治疗率均高于无创呼吸机组,差异均有统计学意义(P<0.05);呼吸湿化治疗仪组胃肠胀气及插管率明显低于无创呼吸机,差异均有统计学意义(P<0.05),两组鼻咽疼痛及死亡率比较差异无统计学意义(P>0.05)。结论:呼吸湿化治疗仪治疗Ⅰ型急性呼吸衰竭效果更好,患者接受治疗时间长,并能降低气管插管率、减少并发症,值得临床推广。
Objective:To explore the clinical efficacy of respiratory humidification treatment apparatus in the treatment of respiratory failure.Method:A total of 102 type I respiratory failure patients by ICU and Respiratory Department of our hospital were selected,Randomized into 51 cases of respiratory humidification therapy group and 51 cases of non-invasive respiratory.Two groups of patients were treated with routine treatment,the patients in both groups were treated with routine therapy,the patients in the respiratory therapy group were treated with respiratory humidification apparatus,and the non-invasive respiratory units were treated with non-invasive ventilator.The clinical curative effect,blood gas index on the 1st day after treatment,acceptance circumstances of treatment time,the number of cases to be inserted,the number of cases of nasopharynx and larynx pain and gastrointestinal distension,and the number of death cases in the two groups were compared.Result:The effective rate of the respiratory humidification group was higher than that of the non invasive breathing unit,the difference was statistically significant(P<0.05).One day after treatment,the partial pressure of oxygen in the two groups was higher than that before treatment and the partial pressure of carbon dioxide was lower than that before treatment(P<0.05),but there was no significant difference in pH value between the two groups(P>0.05).There was no significant difference in oxygen partial pressure and carbon dioxide partial pressure between the two groups 1 day after treatment(P>0.05).The rates of total time(long-term and short-term) and long-term treatment in the respiratory humidification treatment group were higher than those in the non-invasive respiratory group,the differences were statistically significant(P<0.05).The rates of gastrointestinal distention and intubation in the respiratory humidification therapy group was significantly lower than that of the non invasive ventilator,the differences were statistically significant(P<0.05).There was no significant difference between the rates of patients' nasopharyngeal pain and the death toll in two groups(P>0.05).Conclusion:The treatment of type Ⅰ acute respiratory failure with respiratory humidification instrument is more effective.The treatment time is long,and the rate of trachea intubation is reduced,and the complications are reduced.It is worth popularizing in clinical practice.
Objective:To explore the clinical efficacy of respiratory humidification treatment apparatus in the treatment of respiratory failure.Method:A total of 102 type I respiratory failure patients by ICU and Respiratory Department of our hospital were selected,Randomized into 51 cases of respiratory humidification therapy group and 51 cases of non-invasive respiratory.Two groups of patients were treated with routine treatment,the patients in both groups were treated with routine therapy,the patients in the respiratory therapy group were treated with respiratory humidification apparatus,and the non-invasive respiratory units were treated with non-invasive ventilator.The clinical curative effect,blood gas index on the 1st day after treatment,acceptance circumstances of treatment time,the number of cases to be inserted,the number of cases of nasopharynx and larynx pain and gastrointestinal distension,and the number of death cases in the two groups were compared.Result:The effective rate of the respiratory humidification group was higher than that of the non invasive breathing unit,the difference was statistically significant(P<0.05).One day after treatment,the partial pressure of oxygen in the two groups was higher than that before treatment and the partial pressure of carbon dioxide was lower than that before treatment(P<0.05),but there was no significant difference in pH value between the two groups(P>0.05).There was no significant difference in oxygen partial pressure and carbon dioxide partial pressure between the two groups 1 day after treatment(P>0.05).The rates of total time(long-term and short-term) and long-term treatment in the respiratory humidification treatment group were higher than those in the non-invasive respiratory group,the differences were statistically significant(P<0.05).The rates of gastrointestinal distention and intubation in the respiratory humidification therapy group was significantly lower than that of the non invasive ventilator,the differences were statistically significant(P<0.05).There was no significant difference between the rates of patients' nasopharyngeal pain and the death toll in two groups(P>0.05).Conclusion:The treatment of type Ⅰ acute respiratory failure with respiratory humidification instrument is more effective.The treatment time is long,and the rate of trachea intubation is reduced,and the complications are reduced.It is worth popularizing in clinical practice.
引文
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[6]Parke R,Mcguinness S,Eccleston M.Nasal high-flow therapy delivers low level positive airway pressure[J].British Journal of Anaesthesia,2009,103(6):886-890.
[7]王静,齐海蓉,段青梅.高流量湿化氧疗对机械通气脱机患者低氧血症的影响及护理[J].护士进修杂志,2013,28(13):1183-1184.
[8]Dysart K,Miller T L,Wolfson M R,et al.Research in high flow therapy:Mechanisms of action[J].Respiratory Medicine,2009,103(10):1400-1405.
[9]Messika J,Ben K A,Gaudry S,et al.Use of high-flow nasal cannula oxygen therapy in subjects with ARDS:A 1-year observational study[J].Respir Care,2015,60(2):162-169.
[10]叶曜衢,曾燕转,苏月南,等.AIRVO2无创呼吸湿化治疗仪与Trilogy100无创呼吸机在治疗慢性阻塞性肺疾病合并呼吸衰竭患者中的疗效对比研究[J].岭南急诊医学杂志,2016,21(6):615-616.
[11]Schwabbauer N,Berg B,Blumenstock G,et al.Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure:effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation(NIV)[J].BMC Anesthesiology,2014,14(1):66.
[12]陈配配,董丽秀,叶波,等.高流量吸氧湿化仪与无创呼吸机对呼吸衰竭患者的疗效比较[J].海南医学,2017,28(2):291-293.
[13]吴桂英,廖忠莉,李宁.氧中毒发生及其防治研究进展[J].重庆医学,2009,38(8):907-909.
[14]徐莹莹,陈皎.呼吸湿化治疗仪在无创机械通气撤离时的应用[J].中国医师杂志,2014(s2):46-48.
[2]Roy B,Cordova F C,Travaline J M,et al.Full face mask for noninvasive positive-pressure ventilation in patients with acute respiratory failure[J].Journal of the American Osteopathic Association,2007,107(4):148.
[3]王辰,商鸣宇,黄克武.有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致严重呼吸衰竭的研究[J].中华结核和呼吸杂志,2000,23(4):212-216.
[4]Lightowler J V,Elliott M W.Predicting the outcome from NIV for acute exacerbations of COPD[J].Thorax,2000,55(10):815-816.
[5]Wagstaff T A,Soni N.Performance of six types of oxygen delivery devices at varying respiratory rates[J].Anaesthesia,2010,62(5):492-503.
[6]Parke R,Mcguinness S,Eccleston M.Nasal high-flow therapy delivers low level positive airway pressure[J].British Journal of Anaesthesia,2009,103(6):886-890.
[7]王静,齐海蓉,段青梅.高流量湿化氧疗对机械通气脱机患者低氧血症的影响及护理[J].护士进修杂志,2013,28(13):1183-1184.
[8]Dysart K,Miller T L,Wolfson M R,et al.Research in high flow therapy:Mechanisms of action[J].Respiratory Medicine,2009,103(10):1400-1405.
[9]Messika J,Ben K A,Gaudry S,et al.Use of high-flow nasal cannula oxygen therapy in subjects with ARDS:A 1-year observational study[J].Respir Care,2015,60(2):162-169.
[10]叶曜衢,曾燕转,苏月南,等.AIRVO2无创呼吸湿化治疗仪与Trilogy100无创呼吸机在治疗慢性阻塞性肺疾病合并呼吸衰竭患者中的疗效对比研究[J].岭南急诊医学杂志,2016,21(6):615-616.
[11]Schwabbauer N,Berg B,Blumenstock G,et al.Nasal high-flow oxygen therapy in patients with hypoxic respiratory failure:effect on functional and subjective respiratory parameters compared to conventional oxygen therapy and non-invasive ventilation(NIV)[J].BMC Anesthesiology,2014,14(1):66.
[12]陈配配,董丽秀,叶波,等.高流量吸氧湿化仪与无创呼吸机对呼吸衰竭患者的疗效比较[J].海南医学,2017,28(2):291-293.
[13]吴桂英,廖忠莉,李宁.氧中毒发生及其防治研究进展[J].重庆医学,2009,38(8):907-909.
[14]徐莹莹,陈皎.呼吸湿化治疗仪在无创机械通气撤离时的应用[J].中国医师杂志,2014(s2):46-48.
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