目的:探讨高流量经鼻导管氧疗(HFNC)和无创正压通气(NPPV)对海水淹没肺水肿患者的治疗效果。
方法:采用回顾性分析方法。基于秦皇岛市第一医院紧急溺水的Utstein数据库,收集2019年1月1日至2022年12月31日秦皇岛市第一医院急诊科收治的海水淹没性肺水肿患者的临床资料.根据通气方式不同分为NPPV组和HFNC组。一般数据,7天气管插管率,动脉血气分析指标[动脉氧分压(PaO2),二氧化碳的动脉分压(PaCO2),动脉血氧饱和度(SaO2)]和血液动力学指标(收缩压,舒张压,平均动脉压,心率,血乳酸)治疗前后,在重症监护病房(ICU)的住院时间,比较两组氧疗舒适度。
结果:共纳入54例患者,其中NPPV组21例,HFNC组33例。性别差异不显著,年龄,两组之间的意识状态和其他一般信息。与NPPV组相比,HFNC组7天内气管插管率显著降低[24.2%(8/33)vs.33.3%(7/21),P<0.05]。治疗前,两组之间的动脉血气分析和血流动力学没有显着差异。治疗后,两组患者的上述指标均较治疗前明显改善,PaO2,SaO2,收缩压,HFNC组舒张压和平均动脉压明显高于NPPV组[PaO2(mmHg,1mmHg≈0.133kPa):93.56±6.37vs.82.14±6.25,SaO2:1.02±0.09vs.0.95±0.11,收缩压(mmHg):117.37±8.43vs.110.42±8.38,舒张压(mmHg):79.43±7.61vs.72.21±4.32,平均动脉压(mmHg):92.34±6.32vs.85.12±5.38],PaCO2、心率和血乳酸明显低于NPPV组[PaCO2(mmHg):34.26±5.63vs.37.24±6.22,心率(次/分钟):73.38±7.56vs.86.25±5.41,血乳酸(mmol/L):1.38±0.36vs.2.25±1.14],差异均有统计学意义(均P<0.05)。此外,HFNC组ICU住院时间明显短于NPPV组(13.30±2.38天vs.16.27±4.26),氧疗的安慰率明显高于NPPV组[66.7%(22/33)vs.42.8%(9/21)],具有统计学意义(均P<0.05)。
结论:HFNC可改善海水溺水肺水肿患者的氧合,改善血液动力学,降低气管插管率,缩短ICU住院时间,提高氧疗的舒适度,具有一定的临床应用价值。
OBJECTIVE: To investigate the therapeutic effect of high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NPPV) on patients with pulmonary edema caused by seawater
drowning.
METHODS: A retrospective analysis method was used. Based on the Utstein database of emergency
drowning in the First Hospital of Qinhuangdao, the clinical data of patients with seawater
drowning pulmonary edema admitted to the emergency medicine department of the First Hospital of Qinhuangdao from January 1, 2019 to December 31, 2022 were collected. The patients were divided into NPPV group and HFNC group according to different ventilation methods. The general data, endotracheal intubation rate in 7 days, arterial blood gas analysis indexes [arterial partial pressure of oxygen (PaO2), arterial partial pressure of carbon dioxide (PaCO2), arterial oxygen saturation (SaO2)] and hemodynamic indexes (systolic blood pressure, diastolic blood pressure, mean arterial pressure, heart rate, blood lactic acid) before and after treatment, length of stay in intensive care unit (ICU), oxygen therapy comfort of the two groups were compared.
RESULTS: A total of 54 patients were enrolled, including 21 patients in the NPPV group and 33 patients in the HFNC group. There were no significant differences in gender, age, state of consciousness and other general information between the two groups. Compared with NPPV group, the rate of endotracheal intubation in HFNC group within 7 days was significantly lower [24.2% (8/33) vs. 33.3% (7/21), P < 0.05]. Before treatment, there were no significant differences in arterial blood gas analysis and hemodynamics between the two groups. After treatment, the above indexes in both groups were significantly improved compared with those before treatment, and PaO2, SaO2, systolic blood pressure, diastolic blood pressure and mean arterial pressure in HFNC group were significantly higher than those in NPPV group [PaO2 (mmHg, 1 mmHg≈0.133kPa): 93.56±6.37 vs. 82.14±6.25, SaO2: 1.02±0.09 vs. 0.95±0.11, systolic blood pressure (mmHg): 117.37±8.43 vs. 110.42±8.38, diastolic blood pressure (mmHg): 79.43±7.61 vs. 72.21±4.32, mean arterial pressure (mmHg): 92.34±6.32 vs. 85.12±5.38], PaCO2, heart rate and blood lactic acid were significantly lower than those in NPPV group [PaCO2 (mmHg) : 34.26±5.63 vs. 37.24±6.22, heart rate (times/min): 73.38±7.56 vs. 86.25±5.41, blood lactic acid (mmol/L): 1.38±0.36 vs. 2.25±1.14], and the differences were statistically significant (all P < 0.05). In addition, the length of ICU stay in HFNC group was significantly shorter than that in NPPV group (days: 13.30±2.38 vs. 16.27±4.26), and the comfort rate of oxygen therapy was significantly higher than that in NPPV group [66.7% (22/33) vs. 42.8% (9/21)], with statistical significance (all P < 0.05).
CONCLUSIONS: HFNC can improve the oxygenation of patients with pulmonary edema caused by seawater
drowning, improve hemodynamics, reduce the rate of tracheal intubation, shorten the length of ICU stay, and improve the comfort of oxygen therapy, which has certain clinical application value.