經鼻高流量氧療治療肺間質纖維化合并Ⅰ型呼吸衰竭的臨床研究

【摘要】目的 探討經鼻高流量氧療治療肺間質纖維化合并Ⅰ型呼吸衰竭的臨床療效。方法 采用回顧性研究，納入2021年4月至2022年9月甘肅省第二人民醫院收治的70例肺間質纖維化合并Ⅰ型呼吸衰竭患者，所有納入患者分為對照組及治療組，各35例。對照組患者入院后按照基礎疾病給予抗感染、化痰、穩定心率、營養支持等基礎治療，治療組在對照組的基礎上使用高流量吸氧治療。比較兩組患者治療48 h后的臨床療效，治療前、治療48 h后的生命體征、肺功能及血氣指標。結果 治療48 h后，治療組患者的總有效率為82.86%，高于對照組的51.43%（Plt;0.05）。治療48 h后，兩組患者生命體征及酸堿度（pH）值均低于治療前，且治療組在心率（HR）及呼吸頻率（RR）改善方面均優于對照組，pH值低于對照組（Plt;0.05）；而兩組患者第1秒用力呼氣容積（FEV₁）/用力肺活量（FVC）（FEV₁%）、一氧化碳彌散量（DLCO）及二氧化碳分壓（PaCO₂）、氧分壓（PaO₂）均高于治療前，治療組均高于對照組（Plt;0.05）。結論 經鼻高流量氧療可改善特發性肺間質纖維化伴Ⅰ型呼吸衰竭患者的肺功能及相關血氣指標，并可改善患者生命體征，進而有利于提高臨床療效。

【關鍵詞】經鼻高流量氧療；肺間質纖維化；呼吸衰竭；血氣分析；肺功能

中圖分類號：R563.8 文獻標識碼：A 文章編號：2096-2665.2023.14.000.04

DOI：10.3969/j.issn.2096-2665.2023.14.001

Clinical study of nasal high flow oxygen therapy for pulmonary interstitial fibrosis complicated with type Ⅰ respiratory failure

Zhang Jie， Wang Xin， Wei Suzhen

（Department of Respiratory and Critical Care Medicine，Second Provincial People’s Hospital of Gansu， Lanzhou， 730099， Gansu，China）

【Abstract】Objective To investigate the clinical effect of nasal high flow humidified oxygen therapy on pulmonary interstitial fibrosis complicated with type I respiratory failure. Methods A retrospective study was conducted to include 70 patients with pulmonary interstitial fibrosis complicated with type I respiratory failure admitted to the Second People's Hospital of Gansu Province from April 2021 to September 2022. The patients were divided into control group and treatment group， with 35 cases in each group. After admission， patients in control group were given basic treatments such as anti-infection， phlegm reduction， heart rate stabilization and nutritional support according to underlying diseases. The treatment group was given high-flow humidified" oxygen therapy on the basis of the control group. The clinical efficacy， vital signs， lung function and blood gas indices of the two groups were compared before and after treatment for 48 hours. Results After 48 hours of treatment， the total efficacy of the treatment group was 82.86%， which was higher than 51.43% of the control group （Plt;0.05）.After 48 hours of treatment， the vital signs and pH of the two groups were lower than those before treatment， the improvement of HR and RR of treatment group were better than those of control group， and the pH of treatment group was lower than that of control group （Plt;0.05）. The FEV₁%， DLCO， PaCO₂， PaO₂ in the two groups were higher than those before treatment， and treatment group was higher than control group （Plt;0.05）. Conclusion Nasal high-flow oxygen therapy can improve the pulmonary function and blood gas related indices in patients with idiopathic pulmonary interstitial fibrosis and type I respiratory failure， and improve the vital signs of patients， which is conducive to improve the clinical efficacy.

【Keywords】High-flow humidified oxygen therapy; Pulmonary interstitial fibrosis; Respiratory failure; Blood gas analysis; Lung function

特發性肺間質纖維化（idiopathic pulmonary interstitial fibrosis， IPF）是慢性、進行性和纖維化性的肺部疾病，是特發性間質性肺炎最常見的類型，其發病率約等于胃癌、睪丸癌和腦癌的發病率[1-2]。此病患者通常表現為伴有或不伴有干咳的勞力性呼吸困難的非特異性癥狀。然而有的患者肺活量的測定結果和肺容量在間質性肺疾病的早期階段或出現肺氣腫時，可能是正常的?！?br>