高流量鼻导管吸氧与无创机械通气治疗胸部手术术后呼吸功能衰竭的效果比较

目的观察高流量鼻导管吸氧(HFNC)能否降低胸部手术术后气管插管患者在脱机拔管后发生急性呼吸衰竭的再插管率。方法选择2016年1～2017年12月本院ICU收治的46例胸部手术术后撤离呼吸机拔除气管插管后发生急性呼吸衰竭的患者为研究对象。将所有患者按入院时间分成观察组和对照组,每组各23例。对照组患者在发生呼吸衰竭后采用无创机械通气,而观察组患者则采用HFNC。比较两组患者的再插管率。结果观察组的再插管率为17.39%,高于对照组的43.48%,差异具有统计学意义(P0.05)。结论 HFNC可以降低胸部手术术后脱机拔管后发生急性呼吸衰竭患者的再插管率。     

经鼻高流量氧疗与无创正压通气比较治疗慢性阻塞性肺疾病合并中度呼吸衰竭的观察性队列研究北大核心CSCD

目的对比经鼻高流量氧疗（HFNC）和无创通气（NIV）治疗慢性阻塞性肺疾病（COPD）合并急性中度Ⅱ型呼吸衰竭的疗效,探讨HFNC治疗COPD合并呼吸衰竭的可行性。方法回顾性分析2017年4月至2017年12月ICU收治的合并中度Ⅱ型呼吸衰竭（动脉血气pH7．25～7．35,PaCO,〉50mmHg）COPD的患者。人ICU后4h内采用HFNC治疗并持续2h以上,且在第一个24h内至少使用4h者,进入HFNC组;类似使用NIV治疗的患者为NIV组。观察两组治疗失败率（治疗期间患者更换到另一组的呼吸支持方式,或进行有创通气）及28d病死率等指标。结果人选82例患者,其中HFNC组39例,NIV组43例。HFNC组患者治疗失败率为28．2％,低于NIV组（39．5％）,但Kaplan-Meier曲线分析两组差异无统计学意义（LogRank检验1．228,P=0．268）。HFNC组28d病死率为15．4％,与NIV组（14％）差异无统计学意义（LogRank检验0．049,P=0．824）。HFNC组人选24h内气道护理干预次数显著低于NIV组[5（3～8）次比11（7～15）次],而入选24h内呼吸支持时间显著长于NIV组[16（9～22）h比8（4～11）h]（P均〈0．05）。NIV组治疗期间鼻面部皮损发生率为20．9％,显著高于HFNC组的5．1％（P〈0．05）。结论对于COPD合并急性中度Ⅱ型呼吸衰竭,HFNC与NIV具有类似的治疗效果,且HFNC具有更好的治疗耐受性,是临床治疗COPD呼吸衰竭新的有潜力的呼吸支持方式。     

经鼻高流量氧疗治疗急性低氧性呼吸衰竭的疗效

目的探讨经鼻高流量氧疗治疗急性低氧性呼吸衰竭的临床疗效。方法将55例急性低氧性呼吸衰竭患者按随机双盲法分为3组:FM组（n=18）、HFNC组（n=18）和NPPV组（n=19）。FM组采用文丘里呼吸面罩进行氧气吸入,HFNC组采用呼吸湿化治疗仪行经鼻高流量氧疗,NPPV组采用无创呼吸机行经面罩无创正压通气。观察3组治疗前30min和治疗后2hpH、呼吸频率、心率（HR）、舒适度和动脉血二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、动脉血氧饱和度（SpO2）、平均动脉压（MAP）水平的变化。结果与同组治疗前30min比较,治疗后2h,HFNC组、NPPV组呼吸频率下降和PaO2、SpO2水平均升高,FM组PaO2水平升高,NPPV组MAP水平下降,HFNC组舒适度评分升高（均P<0.05）;与FM组比较,HFNC组、NPPV组治疗后2hPaO2水平均升高（均P<0.05）;与HFNC组比较,NPPV组治疗后2hPaO2水平升高（P<0.05）;与FM组、HFNC组比较,NPPV组治疗后2hMAP水平下降（P<0.05）;与FM组、NPPV组比较,HFNC组治疗后2h舒适度评分升高（P<0.05）。结论经鼻高流量氧疗治疗急性低氧性呼吸衰竭具有较好的疗效,可纠正机体缺氧的状态,改善肺功能,并能提供很好的舒适度。     

双相气道正压通气在急性呼吸衰竭脱机过程的应用

目的：探讨双相气道正压通气（BIPAP）治疗急性呼吸衰竭的效果，评价BIPAP与压力支持通气（PSV）在脱机过程中的适用对象。方法：前瞻、随机将36例急性呼吸衰竭患者经APACHE-Ⅱ评分管理并充分齐同平衡．分为BIPAP治疗组和PSV治疗组：每种模式稳定30min后测定呼吸力学、血气指标、患者舒适度评分、治疗结束后记录脱机时间及并发症。结果：两种模式在患者呼吸功、舒适度评分、血气分析方面无统计学差异。结论：BIPAP与PSV均可应用于急性呼吸衰竭脱机过程．PSV更适用于自主通气努力较大患者：相较而言，BIPAP更能减少医务人员管理强度     

有创机械通气-高流量氧疗序贯治疗慢性阻塞性肺疾病所致急性呼吸衰竭的临床研究

目的评价有创机械通气-经鼻高流量氧疗（HFNC）序贯性治疗慢性阻塞性肺疾病（COPD）所致急性呼吸衰竭患者的可行性与临床效果。 方法以2017年3月至2018年5月间盐城市第一人民医院重症医学科（ICU）收治的支气管-肺部感染所致COPD急性呼吸衰竭且需有创机械通气的患者为研究对象。出现肺部感染控制窗（PIC）后随机分为有创-无创序贯治疗组（NIV组）和有创-高流量氧疗序贯治疗组（HFNC组）。观察2组患者一般资料以及急性生理与慢性健康评分Ⅱ（APACHE Ⅱ）、全身性感染相关性功能衰竭评分（SOFA）、临床肺部感染评分（CPIS）;出窗时全身炎症性指标、呼吸力学指标;出窗时及序贯治疗2 h后呼吸、循环指标;48 h再插管率、面部压力性损伤发生率、住ICU时间、住院病死率。 结果（1）共纳入73例患者,其中NIV组38例,HFNC组35例。2组患者入组时一般资料以及APACHE Ⅱ、SOFA、CPIS等评分比较,差异无统计学意义（P>0.05）。（2）2组患者出窗时间及出窗时体温（T）、白细胞计数（WBC）、降钙素原（PCT）、超敏C反应蛋白（hs-CRP）、平均动脉血压（MAP）、心率（HR）、乳酸（Lac）、呼吸频率（RR）、氧分压（PaO₂）、二氧化碳分压（PaCO₂）、氧合指数（P/F）、呼吸舒适度评分、气道阻力（R）、静态肺顺应性（Cstat）、静态内源性呼气末正压（PEEPi-stat）等指标比较,差异均无统计学意义（P>0.05）。（3）与NIV组比较,HFNC组序贯治疗2 h后HR、RR、PaCO₂显著下降［（85.42±11.80）次/min vs （99.38±11.01）次/min,t=3.717,P=0.001;（21.26±5.23）次/min vs （26.88±9.26）次/min,t=2.254,P=0.033;（48.14±5.51）mmHg vs （51.48±4.32）mmHg,t=2.057,P=0.047］,舒适度评分显著升高［（3.92±0.79）分vs（1.83±0.57）分,t=-7.358,P=0.000］。序贯治疗期间HFNC组面部压力性损伤发生率明显于低NIV组（0 vs 21.05%,χ²=8.275,P=0.004）。2组患者脱机后48 h再插管率、患者住ICU时间以及住院病死率比较,差异均无统计学意义（P>0.05）。 结论有创机械通气-HFNC序贯性治疗在改善与维持氧合、48 h再插管率、ICU住院时间、住院病死率等方面与有创-无创序贯方式相当,而且在降低PaCO₂、避免面部压力性损伤发生、提高舒适度等方面有显著的优势。     

呼吸训练器对开胸手术患者肺功能及肺部并发症的影响

胸外科手术造成胸壁肌肉的广泛损伤,术后胸痛明显,呼吸肌破坏较显著,肺功能下降,容易出现肺部感染、肺不张、急性呼吸窘迫综合征（ARDS）、呼吸衰竭等并发症^[1]。作者应用呼吸功能训练器对开胸手术患者进行术后呼吸功能训练,使肺功能得到不同程度改善,从而降低开胸术后肺部并发症发生率。     

经鼻高流量氧气疗法在治疗急性呼吸衰竭中的临床应用研究进展

从临床应用特点和应用对象方面综述经鼻高流量氧气疗法(HFNC)在治疗急性呼吸衰竭中的临床应用研究进展。指出HFNC在治疗急性低氧性呼吸衰竭方面发挥了明确的作用,目前国内HFNC的使用大多是结合国外文献资料,实验型研究数据仍缺乏,因此需要针对国内病人特征,制定符合国内居民的个性化治疗方案。     

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

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 mm Hg(1 mm Hg=0.133 k Pa)为轻度缺氧组,101～200 mm Hg为中度...     

有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致呼吸衰竭的临床研究

目的探讨有创与无创序贯性机械通气在慢性阻塞性肺疾病（COPD）所致呼吸衰竭患者救治中的方法与疗效。方法对41例COPD呼吸衰竭患者进行气管插管并施行机械通气,出现HC窗后,随机分为序贯治疗组（21例）和对照组（20例）。序贯组治疗方法：出现PIC窗后,立即拔出气管插管,改用口鼻面罩双水平气道正压通气（BiPAP）。对照组治疗方法：出现HC窗后,继续按常规有创机械通气方法治疗,按临床常用压力支持通气（PSV）模式脱机。两组同时进行监护,观察两组患者VAP发生例数、有创通气时间、总机械通气时间、ICU监护时间、住院时间、住院费用和院内死亡例数。结果序贯组与对照组比较,VAP发生少,有创通气时间、总通气时间、ICU监护时间及住院时间短,住院费用减少（P〈0．05）,差异有统计学意义。结论在“肺部感染控制窗”指导下的有创一无创序贯性脱机治疗方法,可以明显降低VAP发病率,缩短机械通气,ICU和总住院时间,提高疗效,降低治疗费用,是具有一定临床实用价值的有效脱机方案。     

无创机械通气与经鼻高流量氧疗对老年呼吸衰竭患者的临床疗效比较

目的 分析两种氧疗方式应用于老年呼吸衰竭患者的临床疗效。方法 2019年1月至2021年12月我院收治的老年呼吸衰竭患者152例,按照随机数字表法分为两组各76例,常规组予以无创机械通气支持,经鼻高流量氧气湿化(HFNC)组给予HFNC治疗,比较两组肺通气功能、症状完全缓解时间(咳痰缓解时间、气喘缓解时间、咳嗽缓解时间)、实验室指标变化情况,两组插管率及住院时间。结果 治疗后与常规组比较,HFNC组肺通气功能指标更高,各症状完全缓解时间、实验室指标更低(P<0.05);两组插管率、住院时间差异无统计学意义(P>0.05)。结论 HFNC在改善老年呼吸衰竭肺通气功能中有明显优势,可促进其症状缓解,抑制肺部血管收缩及肺部炎症反应。     

Early high-flow nasal cannula oxygen therapy in adults with acute hypoxemic respiratory failure in the ED: A before-after study

ObjectivesTo compare clinical impact after early initiation of high-flow nasal cannula oxygen therapy (HFNC) versus standard oxygen in patients admitted to an emergency department (ED) for acute hypoxemic respiratory failure.MethodsWe performed a prospective before-after study at EDs in two centers including patients with acute hypoxemic respiratory failure defined by a respiratory rate above 25 breaths/min or signs of increased breathing effort under additional oxygen for a pulse oximetry above 92%. Patients with cardiogenic pulmonary edema or exacerbation of chronic lung disease were excluded. All patients were treated with standard oxygen during the first period and with HFNC during the second. The primary outcome was the proportion of patients with improved respiratory failure 1 h after treatment initiation (respiratory rate ≤ 25 breaths/min without signs of increased breathing effort). Dyspnea and blood gases were also assessed.ResultsAmong the 102 patients included, 48 were treated with standard oxygen and 54 with HFNC. One hour after treatment initiation, patients with HFNC were much more likely to recover from respiratory failure than those treated with standard oxygen: 61% (33 of 54 patients) versus 15% (7 of 48 patients), P < 0.001. They also showed greater improvement in oxygenation (increase in PaO₂ was 31 mm Hg [0–67] vs. 9 [−9–36], P = 0.02), and in feeling of breathlessness.ConclusionsAs compared to standard oxygen, patients with acute hypoxemic respiratory failure treated with HFNC at the ED had better oxygenation, less breathlessness and were more likely to show improved respiratory failure 1 h after initiation.     

High flow nasal cannula for adult acute hypoxemic respiratory failure in the ED setting

IntroductionHigh flow nasal cannula (HFNC) is a noninvasive ventilation (NIV) system that has demonstrated promise in the emergency department (ED) setting.ObjectiveThis narrative review evaluates the utility of HFNC in adult patients with acute hypoxemic respiratory failure in the ED setting.DiscussionHFNC provides warm (37 °C), humidified (100% relative humidity) oxygen at high flows with a reliable fraction of inspired oxygen (FiO₂). HFNC can improve oxygenation, reduce airway resistance, provide humidified flow that can flush anatomical dead space, and provide a low amount of positive end expiratory pressure. Recent literature has demonstrated efficacy in acute hypoxemic respiratory failure, including pneumonia, acute respiratory distress syndrome (ARDS), coronavirus disease 2019 (COVID-19), interstitial lung disease, immunocompromised states, the peri-intubation state, and palliative care, with reduced need for intubation, length of stay, and mortality in some of these conditions. Individual patient factors play an important role in infection control risks with respect to the use of HFNC in patients with COVID-19. Appropriate personal protective equipment, adherence to hand hygiene, surgical mask placement over the HFNC device, and environmental controls promoting adequate room ventilation are the foundation for protecting healthcare personnel. Frequent reassessment of the patient placed on HFNC is necessary; those with severe end organ dysfunction, thoracoabdominal asynchrony, significantly increased respiratory rate, poor oxygenation despite HFNC, and tachycardia are at increased risk of HFNC failure and need for further intervention.ConclusionsHFNC demonstrates promise in several conditions requiring respiratory support. Further randomized trials are needed in the ED setting.     

脱机拔管后呼吸衰竭患者序贯经鼻高流量湿化氧疗失败的危险因素分析

目的分析拔管后仍存在呼吸衰竭的患者序贯经鼻高流量湿化氧疗（HFNC）失败率及其危险因素。 方法回顾性分析2017年1月1日至2019年3月31日入住福建省立医院ICU气管插管拔管后行序贯HFNC的145例患者。根据HFNC成功与否将其分为HFNC成功组（113例）和HFNC失败组（32例）。比较两组患者的临床资料及实验室指标,并采用Logistic回归分析探究HFNC治疗失败的独立危险因素。 结果HFNC成功组和HFNC失败组患者插管原因（χ² = 11.224,P = 0.024）、慢性心力衰竭（χ² = 4.863,P = 0.027）、心脏瓣膜病（χ² = 6.435,P = 0.011）、呼吸道病原学阳性（χ² = 8.909,P = 0.003）,拔管当天序贯器官衰竭估计评分（Z = 2.138,P = 0.032）、急性病生理学和长期健康评价Ⅱ评分（t = 2.307,P = 0.023）,插管期间使用血管活性药物（χ² = 4.153,P = 0.042）和雾化N-乙酰半胱氨酸（χ² = 4.531,P = 0.033）,拔管前2 d内中性粒细胞计数（t = 2.170,P = 0.032）、淋巴细胞总数<0.8 × 10⁹/L（χ² = 5.941,P = 0.024）、降钙素原（Z = 2.656,P = 0.008）比较,差异均有统计学意义。多因素Logistic回归分析结果显示,拔管前2 d内外周血淋巴细胞总数<0.8 × 10⁹/L[比值比（OR）= 2.898,95%置信区间（CI）（1.059,7.935）,P = 0.038]和呼吸道病原学阳性[OR = 4.617,95%CI（1.463,14.568）,P = 0.009]为HFNC失败的独立危险因素。 结论拔管前2 d内外周血淋巴细胞计数<0.8 × 10⁹/L和呼吸道病原体阳性为气管插管拔管后仍存在呼吸衰竭的患者序贯HFNC失败的独立危险因素。     

Factors associated with failure of high-flow nasal cannula oxygen therapy in patients with severe COVID-19: a retrospective case series

ObjectiveTo identify factors associated with high-flow nasal cannula (HFNC) therapy failure in patients with severe COVID-19.MethodsWe retrospectively examined clinical and laboratory data upon admission, treatments, and outcomes of patients with severe COVID-19. Sequential Organ Failure Assessment (SOFA) scores were also calculated.ResultsOf 54 patients with severe COVID-19, HFNC therapy was successful in 28 (51.9%) and unsuccessful in 26 (48.1%). HFNC therapy failure was more common in patients aged ≥60 years and in men. Compared with patients with successful HFNC therapy, patients with HFNC therapy failure had higher percentages of fatigue, anorexia, and cardiovascular disease; a longer time from symptom onset to diagnosis; higher SOFA scores; a higher body temperature, respiratory rate, and heart rate; more complications, including acute respiratory distress syndrome, septic shock, myocardial damage, and acute kidney injury; a higher C-reactive protein concentration, neutrophil count, and prothrombin time; and a lower arterial partial pressure of oxygen/fraction of inspired oxygen (PaO₂/FiO₂). However, male sex, a low PaO₂/FiO₂, and a high SOFA score were the only independent factors significantly associated with HFNC therapy failure.ConclusionsMale sex, a low PaO₂/FiO₂, and a high SOFA score were independently associated with HFNC therapy failure in patients with severe COVID-19.     

High-flow nasal cannula oxygen versus non-invasive ventilation in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy - a prospective randomised trial

Introduction

Critically ill patients with respiratory failure undergoing bronchoscopy have an increased risk of hypoxaemia-related complications. Previous studies have shown that in awake, hypoxaemic patients non-invasive ventilation (NIV) is helpful in preventing gas exchange deterioration during bronchoscopy. An alternative and increasingly used means of oxygen delivery is its application via high-flow nasal cannula (HFNC). This study was conducted to compare HFNC with NIV in patients with acute hypoxaemic respiratory failure undergoing flexible bronchoscopy.

Methods

Prospective randomised trial randomising 40 critically ill patients with hypoxaemic respiratory failure to receive either NIV or HFNC during bronchoscopy in the intensive care unit.

Results

After the initiation of NIV and HFNC, oxygen levels were significantly higher in the NIV group compared to the HFNC group. Two patients were unable to proceed to bronchoscopy after the institution of HFNC due to progressive hypoxaemia. During bronchoscopy, one patient on HFNC deteriorated due to intravenous sedation requiring non-invasive ventilatory support. Bronchoscopy was well tolerated in all other patients. There were no significant differences between the two groups regarding heart rate, mean arterial pressure and respiratory rate. Three patients in the NIV group and one patient in the HFNC group were intubated within 24 hours after the end of bronchoscopy (P = 0.29).

Conclusions

The application of NIV was superior to HFNC with regard to oxygenation before, during and after bronchoscopy in patients with moderate to severe hypoxaemia. In patients with stable oxygenation under HFNC, subsequent bronchoscopy was well tolerated.

Trial registration

ClinicalTrials.gov {"type":"clinical-trial","attrs":{"text":"NCT01870765","term_id":"NCT01870765"}}NCT01870765. Registered 30 May 2013.     

Predicting success of high-flow nasal cannula in pneumonia patients with hypoxemic respiratory failure: The utility of the ROX index

PurposeThe purpose of the study is to describe early predictors and to develop a prediction tool that accurately identifies the need for mechanical ventilation (MV) in pneumonia patients with hypoxemic acute respiratory failure (ARF) treated with high-flow nasal cannula (HFNC).Materials and methodsThis is a 4-year prospective observational 2-center cohort study including patients with severe pneumonia treated with HFNC. High-flow nasal cannula failure was defined as need for MV. ROX index was defined as the ratio of pulse oximetry/fraction of inspired oxygen to respiratory rate.ResultsOne hundred fifty-seven patients were included, of whom 44 (28.0%) eventually required MV (HFNC failure). After 12 hours of HFNC treatment, the ROX index demonstrated the best prediction accuracy (area under the receiver operating characteristic curve 0.74 [95% confidence interval, 0.64-0.84]; P < .002). The best cutoff point for the ROX index was estimated to be 4.88. In the Cox proportional hazards model, a ROX index greater than or equal to 4.88 measured after 12 hours of HFNC was significantly associated with a lower risk for MV (hazard ratio, 0.273 [95% confidence interval, 0.121-0.618]; P = .002), even after adjusting for potential confounding.ConclusionsIn patients with ARF and pneumonia, the ROX index can identify patients at low risk for HFNC failure in whom therapy can be continued after 12 hours.     

Extent of pleural effusion on chest radiograph is associated with failure of high-flow nasal cannula oxygen therapy

PurposeThe purpose of the study was to determine whether pleural effusion (PE) is associated with a failure of high-flow nasal cannula (HFNC) therapy.Materials and methodsWe conducted a single-center retrospective study. Seventy-three patients with acute respiratory failure given HFNC therapy between January 2012 and December 2014 were reviewed. HFNC failure was defined as intubation or noninvasive positive pressure ventilation following HFNC therapy. The numbers of quadrants with consolidation or ground glass opacity were counted on chest radiographs performed within 24 hours before starting HFNC therapy, and the PE score was calculated. PE score was the original score, verified by the computed tomographic images of some of the study patients.ResultsOverall, 29 of 73 experienced HFNC failure. PE score was significantly greater in the HFNC failure group, but the number of quadrants with opacity was not significantly different. Age and Sequential Organ Failure Assessment (SOFA) score were significantly greater in the HFNC failure group. The PE (odds ratio, 1.49; 95% confidence interval, 1.10-2.02; P = .01) and SOFA (odds ratio, 1.33; 95% confidence interval, 1.05-1.68; P = .02) scores were independently associated with HFNC failure in multivariate analysis.ConclusionsThe extent of PE on chest radiograph and SOFA score were associated with HFNC failure.     

Beneficial effects of humidified high flow nasal oxygen in critical care patients: a prospective pilot study

Purpose  

To evaluate the efficiency, safety and outcome of high flow nasal cannula oxygen (HFNC) in ICU patients with acute respiratory failure.     

间质性肺炎急性加重期伴呼吸衰竭患者高流量鼻导管氧疗治疗无效的影响因素

目的分析间质性肺炎急性加重期（AE-IP）伴呼吸衰竭（RF）患者高流量鼻导管氧疗（HFNC）治疗无效的影响因素。 方法选择白银市第一人民医院呼吸与危重症医学一部2019年8月至2021年8月136例AE-IP伴RF患者作为研究对象,记录患者资料,进行HFNC治疗,完成1周治疗后观察治疗效果,分为无效组、有效组,比较2组资料,使用Logistic回归分析检验,找出AE-IP伴RF患者HFNC治疗无效的影响因素。 结果治疗1周,研究内136例AE-IP伴RF患者HFNC治疗无效发生率为16.91%（23/136）;无效组呼吸道感染占比、营养不良占比均高于有效组,氧合指数低于有效组,B型钠尿肽（BNP）、降钙素原（PCT）均高于有效组,差异有统计学意义（P＜0.05）;其余资料比较,差异无统计学意义（P＞0.05）;Logistic回归分析结果显示,氧合指数、BNP、PCT、呼吸道感染、营养不良与AE-IP伴RF患者HFNC治疗无效有关,氧合指数低、BNP高、PCT高、呼吸道感染、营养不良可能是AE-IP伴RF患者HFNC治疗无效的风险因素（OR＞1,P＜0.05）;森林图显示,在AE-IP伴RF患者HFNC治疗无效的相关因素中,营养不良的关联度最强。 结论AE-IP伴RF患者HFNC治疗有一定的无效风险,可能与氧合指数低、BNP高、PCT高、呼吸道感染、营养不良有关。