目的 探讨经鼻高流量氧疗在重症急性胰腺炎患者中的应用效果。方法 选取2015年1月—2016年5月收治的重症急性胰腺炎患者为对照组,2016年6月—2017年12月收治的重症急性胰腺炎患者为观察组,对照组采用鼻导管或面罩吸氧的传统吸氧方式,观察组先采用传统吸氧后序贯经鼻高流量氧疗,比较2组患者的生理指标、呼吸困难程度、气管插管率和预后。结果 与对照组相比,观察组患者的生理指标得到明显改善（P<0.05）,患者的呼吸困难程度明显缓解（P<0.001）,患者的气管插管率降低,但差异无统计学差异（P>0.05）,预后无明显改善（P>0.05）。结论 经鼻高流量氧疗可以明显提高重症急性胰腺炎患者血氧饱和度,缓解患者呼吸困难,但不能明显降低气管插管率和改善患者预后。
Abstract
Objective To explore the effect of high-flow nasal cannula (HFNC) oxygen therapy in patients with severe acute pancreatitis. Methods Patients with severe acute pancreatitis from January 2015 to May 2016 were enrolled in the control group and those from June 2016 to December 2017 in the observation group. Conventional oxygen therapy was adopted in the control group but in the observation group HFNC oxygen therapy was used after conventional oxygen therapy. Physiological indicators, degree of dyspnea, endotracheal intubation rate and prognosis in the 2 groups were compared. Results Physiological indicators in the observation group were improved significantly (P<0.05) and patients' difficulty in breathing was relieved obviously (P<0.001). There was decreased rate of endotracheal intubation but without statistical significance (P>0.05) and no significant improvement was found in the prognosis in the observation group (P>0.05). Conclusion For patients with severe acute pancreatitis, HFNC oxygen therapy is conducive to the improvement of oxyhemoglobin saturation and the relief of patients' breath difficulty but it is not effective for lowering the rate of endotracheal intubation and improving the prognosis.
关键词
经鼻高流量氧疗 /
重症急性胰腺炎 /
成人 /
护理
Key words
HFNC oxygen therapy /
severe acute pancreatitis /
adult /
nursing
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] 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):66-67.DOI:10.1186/1471-2253-14-66.
[2] Frat J P, Brugiere B, Ragot S, et al.Sequential Application of Oxygen Therapy Via High-flow Nasal Cannula and Noninvasive Ventilation in Acute Respiratory Failure: An Observational Pilot Study[J]. Respiratory Care,2015,60(2):170-178.DOI:10.4187/respcare.03075.
[3] Maggiore sM, Idone F A, Vaschetto R, et al. Nasal High-now Versus Venturi Mask Oxygen Thempy ter Extubation.Efkcts on Oxygenation, Comfort, and Clinical Outcome[J].Am J Respir Crit Care Med,2014, 190(3):282-288.DOI:10.1164/rccm.201402-0364OC.
[4] Nishimura M.High-flow Nasal Cannula Oxygen Therapy in Adults: Physiological Benefits, Indication,Clinical Benefits, and Adverse Effects[J].Respiratory Care,2016, 61(4):529-541. DOI:10.4187/respcare.04577.
[5] Harada K, Kurosawa S, Hino Y, et al.Clinical Utility of High-flow Nasal Cannula Oxygen Therapy for Acute Respiratory Failure in Patients with Hematological Disease[J].Springerplus, 2016,5(1):1-6.DOI:1186/s40064-016-2161-1.
[6] 中华医学会消化病学分会胰腺疾病学组,中华胰腺病杂志编辑委员会,中华消化杂志编辑委员会.中国急性胰腺炎诊治指南(2013年,上海)[J].中华消化杂志,2013,13(4):217-222. DOI:10.3760/cma.j.issn.0254-1432.2013.04.001.
[7] 李伟伟,冯慧远,田昭涛,等.早期肠内营养对急性重症胰腺炎肠黏膜屏障及炎症指标的影响[J].实用医学杂志,2018,34(16):2722-2725.DOI:10.3969/j.issn.1006-5725.2018.16.021.
[8] Ciprandi G, Schiavetti I, Sorbello V, et al.Perception of Asthma Symptoms as Assessed on the Visual Analog Scale in Subjects with Asthma: A Real-life Study[J]. Respiratory Care, 2016, 61(1):23-29.DOI:10.4187/respcare.04171.
[9] 金玉梅,徐敏娟,曹李丽.高流量湿化氧疗系统在PICU呼吸系统疾病患儿面罩吸氧中应用效果分析[J]. 护理学报,2014,21(14):5-7.DOI:10.16460/j.issn1008-9969.2014.14.004.
[10] Ion D, Bolocan A, Radu G, et al.Particularities in the Evolution of Mortality by Traumatic Events in the Last 30 Years[J].Chirurgia, 2017,112(6):690-695.DOI:10.21614/chirurgia.112.6.690.
[11] Nagata K, Kikuchi T, Horie T, et al.Domiciliary High-Flow Nasal Cannula Oxygen Therapy for Stable Hypercapnic COPD Patients: A Multicenter, Randomized Crossover Trial[J].Annals ATS, 2018,15(4):432-439.DOI:10.1513/AnnalsATS.201706-425OC.
[12] Frizzola M, Miller T L, Rodriguez M E, et al.High flow Nasal Cannula: Impact on Oxygenation and Ventilation in an Acute Lung Injury Model[J]. Pediatric Pulmonology, 2011, 46(1):67-74. DOI:10.1002/ppul.21326.
[13] Makdee O, Monsomboon A, Surabenjawong U, et al.High-Flow Nasal Cannula Versus Conventional Oxygen Therapy in Emergency Department Patients with Cardiogenic Pulmonary Edema: A Randomized Controlled Trial[J]. Ann Emerg Med,2017,70(4):465-472.DOI:10.1016/j.annemergmed.2017.03.028.
[14] Bressan S, Balzani M, Krauss B, et al.High-flow Nasal Cannula Oxygen for Bronchiolitis in a Pediatric Ward: A Pilot Study[J]. Eur J Pediatr, 2013, 172(12):1649-1656. DOI:10.1007/s00431-013-2094-4.
[15] Corley A, Caruana L R, Barnett A G, et al.Oxygen Delivery Through High-flow Nasal Cannulae Increase End-expiratory Lung Volume and Reduce Respiratory Rate in Post-cardiac Surgical Patients[J]. Br J Anaesth, 2011,107(6):998-1004.DOI:10.1093/bja/aer265.
[16] Groves N, Tobin A.High Flow Nasal Oxygen Generates Positive Airway Pressure in Adult Volunteers[J]. Australian Critical Care,2007,20(4):126-131.DOI:10.1016/j.aucc.2007.08.001.
[17] Parke R L, Mcguinness S P.Pressures Delivered by Nasal High Flow Oxygen during all Phases of the Respiratory Cycle[J]. Respiratory Care, 2013, 58(10):1621-4.DOI:10.4187/respcare.02358.
[18] Kang B J, Koh Y, Lim C M, et al.Failure of High-flow Nasal Cannula Therapy May Delay Intubation and Increase Mortality[J]. Intensive Care Med, 2015,41(4):623-632. DOI:10.1007/s00134-015-3693-5.
PDF(428 KB)
