摘要
目的研究颅脑疾病伴急性低氧性呼吸衰竭(AHRF)患者经鼻高流量氧疗(HFNC)治疗失败的危险因素。方法回顾性分析2017年8月至2018年12月我院神经外科监护病房颅脑疾病伴AHRF患者接受HFNC治疗81例的病历资料。经HFNC治疗后,转为行机械通气(包括有创通气及无创通气)归为治疗失败组,无需行机械通气归为治疗成功组,比较两组HFNC治疗前基线资料和治疗前、治疗6h、24h后相关呼吸指标,分析影响HFNC治疗失败的危险因素。结果81例患者中,治疗失败组21例(25.93%),治疗成功组60例(74.07%)。两组性别、年龄、BMI、治疗前临床肺部感染评分(CPIS)、白蛋白、血清c反应蛋白(CRP)、血清降钙素原(PCT)及痰液湿化满意度,差异均无统计学意义(P>0.05);两组治疗前乳酸水平、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)评分、格拉斯哥昏迷量表评分(GCS)、有无腹胀、舌根后坠、咳嗽反射,差异均有统计学意义(P<0.05);呼吸指标表明,成功组较失败组通气24h后呼吸频率明显降低,PaO2/FiO2得到有效改善,差异有统计学意义(P<0.05),是影响HFNC治疗失败的因素;其中APACHEⅡ评分、GCS评分、咳嗽反射是影响HFNC治疗失败的独立危险因素。结论患者治疗前APACHEⅡ评分、GCS评分、咳嗽反射是影响HFNC治疗失败的独立危险因素,治疗24h后呼吸频率、PaO2/FiO2能否得到改善是转为机械通气的重要指标。
Objective To study the risk factors for failure of nasal high-flow oxygen therapy(HFNC)in patients with craniocerebral diseases and acute hypoxic respiratory failure(AHRF).Methods A retrospective analysis was performed on the medical records of 81 patients with craniocerebral disease and AHRF who underwent HFNC therapy in neurosurgical intensive care unit of our hospital from August 2017 to December 2018.The failure group after HFNC treatment was converted to mechanical ventilation(including invasive ventilation and non-invasive ventilation).No mechanical ventilation was required in the successful HFNC treatment group.The baseline data of patients in the two groups before treatment were compared,and the respiratory related indicators at pre-treatment,6 h and 24 h after treatment,to analyze the risk factors that caused HFNC treatment failure.Results Among the 81 patients,21 cases(25.93%)were in the treatment failure group and 60(74.07%)were in the treatment success group.There was no significant differences in sex,age,BMI,pre-treatment clinical pulmonary infection score(CPIS),albumin,serum c-reactive protein(CRP),serum procalcitonin(PCT),and sputum humidification satisfaction(P>0.05).These indicators had statistical significant differences,including pre-treatment lactate level,acute physiology and chronic health status scoreⅡ(APACHEⅡ)score,Glasgow Coma Scale score(GCS),presence or absence of bloating,tongue drop and cough reflex(P<0.05).Respiratory related indicators comparison showed that the respiratory rate was significantly lower in the successful treatment group than that in the failed treatment group after 24 h ventilation,The level of PaO2/FiO2 was effectively improved,and the difference was statistically significant(P<0.05).Thus this was the influence factors that caused HFNC treatment failure.APACHEⅡscore,GCS score and cough reflex were the independent risk factors for HFNC treatment failure.Conclusion APACHEⅡscore,GCS score and cough reflex are the independent risk factors for HFNC treatment failure.The improvement of respiratory rate and PaO2/FiO2 after 24 hours of treatment is an important indicator for further mechanical ventilation.
作者
镇坷
童孜蓉
赵倩
赵琳
ZHEN Ke;TONG Zi-rong;ZHAO Qian;ZHAO Lin(ICU in Neurosurgery Department,the First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu210000,China)
出处
《临床肺科杂志》
2020年第1期65-69,共5页
Journal of Clinical Pulmonary Medicine
关键词
颅脑疾病
急性低氧性呼吸衰竭
经鼻高流量氧疗
危险因素
craniocerebral disease
acute hypoxic respiratory failure
nasal high-flow oxygen therapy
risk factors
