经鼻高流量氧疗治疗Ⅰ型呼吸衰竭的疗效分析

目的 探讨经鼻高流量氧疗（HFNC）对Ⅰ型呼吸衰竭患者氧疗效果、舒适度及吞咽功能的影响。方法 选择2016 年8 月-2017 年3 月在中南大学湘雅医院重症医学科住院的Ⅰ型呼吸衰竭患者48 例，随机分成无创正压通气（NPPV）组和HFNC 组，每组24 例。比较2 种通气方式在不同时间点的呼吸频率（RR）、氧合指数。比较两组患者治疗过程中舒适度、腹胀发生率、吞咽功能、营养供给途径方面的差异。结果 两组患者RR、氧合指数较治疗前改善（P <0.05）。HFNC 组患者RR 较NPPV 组降低（P <0.05）。两组患者氧合指数比较，差异无统计学意义（P >0.05）。HFNC 组患者治疗过程中疼痛和腹胀引起的不舒适较NPPV组少（P <0.05）。HFNC 组患者治疗过程中吞咽功能影响较少，洼田饮水实验评定优于NPPV 组（P <0.05）。两组经口进食比例比较，差异无统计学意义（P >0.05）。结论 与NPPV 相比，HFNC 具有良好的舒适度，且腹胀发生率减少。HFNC 能改善患者呼吸窘迫，且在治疗过程中对患者吞咽功能影响较少。

Effect of high-flow nasal cannula oxygen therapy on type I respiratory failure

Objective To explore the impact of high-flow nasal cannula oxygen therapy (HFNC) on oxygentherapy, comfort level and swallowing function in patients with type I respiratory failure. Methods Forty-eightpatients with type I respiratory failure registered from Department of Critical Care Medicine, Xiangya Hospital,Central South University between August 2016 and March 2017. The patients were randomized to two groups, eachgroup contained 24 patients. The control group was treated with noninvasive positive pressure ventilation (NPPV), theobservation group was treated with HFNC. The respiratory frequency and oxygenation index at different time points(0, 2, 6, 24 and 48 h), and the differences in the comfort level, incidence of abdominal distension, swallowing functionand nutrition support pathway during the process of treatment were compared between the two groups. Results After48 h of treatment, the respiratory rate and oxygenation index were significantly improved in both groups (P < 0.05).HFNC was better than NPPV in the improvement of respiratory rate (P < 0.05), but there was no significant differencein the improvement of oxygenation index between the two groups (P > 0.05). Compared with the NPPV group, thediscomfort related to pain was less in the HFNC group (P < 0.05), also the incidence of abdominal distension waslower (P < 0.05). The swallowing function in the HFNC group was less affected in the process of treatment, the resultof Kubota water drinking test was better than that in the NPPV group (P < 0.05). The proportion of oral feedingtended to be higher in the HFNC group but did not have statistical difference (P > 0.05). Conclusions Compared with NPPV, HFNC is associated with more comfort, and significantly reduced incidence of abdominal distension.HFNC could obviously improve the respiratory distress of the patients, swallowing function is less affected in theprocess of treatment.