【论著】呼气湿化治疗仪在急性左心衰竭爆发病人中应用的初步探讨△
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_gif/fmBfsy8GtsBnCbvJ8tgAXvJUlrAR144sHUD7Dc7nBkebu0icL2PKp2hN96nhFQ8Sjwy8yZe4rpNrtDk8rbI8DDA/640?wx_fmt=gif&tp=webp&wxfrom=5&wx_lazy=1" style="width: 50%; margin-bottom: 20px;"></span></p><span style="color: black;"><span style="color: black;"><strong style="color: blue;">版权声明：本平台致力分享好文精选、精读。部分<span style="color: black;">文案</span>推送时未能与<span style="color: black;">原作者取得联系。若<span style="color: black;">触及</span>版权问题，敬请原作者在本公<strong style="color: blue;"><span style="color: black;">号留言删除！</span></strong></span></strong></span></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">本文刊于：岭南心血管病杂志，2021，27（02）：180-183</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">作者：</span></strong><span style="color: black;">叶龙彪，李 彬，夏 爽</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">通讯作者：</span></strong><span style="color: black;"><span style="color: black;">夏 爽</span></span></p><span style="color: black;"><span style="color: black;">摘要</span></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">目的</strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">初步探讨经鼻高流量湿化氧疗（<span style="color: black;">high-flow nasal cannula oxygen therapy, HFNC</span>）对急性左心衰竭<span style="color: black;">爆发</span><span style="color: black;">病人</span>的辅助治疗<span style="color: black;">功效</span>。</span></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">办法</span> </span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">入选</span><span style="color: black;">2018</span><span style="color: black;">年</span><span style="color: black;">12</span><span style="color: black;">月至</span><span style="color: black;">2020</span><span style="color: black;">年</span><span style="color: black;">6</span><span style="color: black;">月间，陆河县人民医院急诊收治的急性左心衰竭<span style="color: black;">病人</span>共</span><span style="color: black;">72</span><span style="color: black;">例，年龄（</span><span style="color: black;">73.61±9.47</span><span style="color: black;">岁），按随机数字表法随机分为</span><span style="color: black;">2</span><span style="color: black;">组：常规治疗组</span><span style="color: black;">36</span><span style="color: black;">例，其中男女各</span><span style="color: black;">18</span><span style="color: black;">例，年龄（</span><span style="color: black;">72.16±9.77</span><span style="color: black;">）岁，采用传统抗心力衰竭治疗；</span><span style="color: black;"> HFNC</span><span style="color: black;">组</span><span style="color: black;">36</span><span style="color: black;">例，其中男</span><span style="color: black;">15</span><span style="color: black;">例，女</span><span style="color: black;">21</span><span style="color: black;">例，年龄（</span><span style="color: black;"> 74.11±8.32</span><span style="color: black;">）岁，于传统抗心力衰竭治疗后</span><span style="color: black;">2 h</span><span style="color: black;">采用</span><span style="color: black;">HFNC</span><span style="color: black;">治疗。比较两组<span style="color: black;">病人</span>的治疗疗效。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">结果</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">常规治疗组有</span><span style="color: black;">5</span><span style="color: black;">例（</span><span style="color: black;">13.9%</span><span style="color: black;">）<span style="color: black;">病人</span><span style="color: black;">必须</span>气管插管上<span style="color: black;">呼气</span>机治疗；而</span><span style="color: black;">HFNC</span><span style="color: black;">组仅</span><span style="color: black;">1</span><span style="color: black;">例（</span><span style="color: black;">2.8%</span><span style="color: black;">）<span style="color: black;">病人</span><span style="color: black;">必须</span>气管插管上<span style="color: black;">呼气</span>机治疗，两组比较差异有统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.01</span><span style="color: black;">）。治疗后，与常规治疗组比较，</span><span style="color: black;">HFNC</span><span style="color: black;"><span style="color: black;">病人</span>的心率及<span style="color: black;">呼气</span>频率减慢，氨基末端脑钠肽前体（</span><span style="color: black;">N-terminal pro-brain natriuretic peptide, NT-proBNP</span><span style="color: black;">）浓度降低，血氧饱和度和氧分压均<span style="color: black;">上升</span>，差异有统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.01</span><span style="color: black;">）。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">结论 </span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><span style="color: black;">HFNC</span>有助于急性左心衰<span style="color: black;">病人</span>生命征的稳定，在短期内<span style="color: black;">加强</span><span style="color: black;">病人</span>的血氧饱和度及氧分压，降低<span style="color: black;">NT-proBNP</span>浓度，改善急性左心衰<span style="color: black;">病人</span>的短期症状。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">急性左心衰竭是极为<span style="color: black;">平常</span>的急<span style="color: black;">严重</span>症之一，它<span style="color: black;">指的是</span>急性的心脏病变<span style="color: black;">导致</span>左心收缩力<span style="color: black;">显著</span>降低而<span style="color: black;">引起</span>急性心排血量<span style="color: black;">明显</span>、急剧的降低，肺循环压力<span style="color: black;">忽然</span><span style="color: black;">升高</span>，<span style="color: black;">引起</span>组织器官灌注不足和急性肺淤血的临床表现。在治疗上，纠正低氧是极其<span style="color: black;">要紧</span>的一环</span><span style="color: black;"></span><span style="color: black;">。近年来，一种采用<span style="color: black;">呼气</span>湿化治疗仪的新型<span style="color: black;">没</span>创通气治疗方式</span><span style="color: black;">-</span><span style="color: black;">经鼻高流量湿化氧疗（</span><span style="color: black;">high-flow nasal cannula oxygen therapy, HFNC</span><span style="color: black;">），<span style="color: black;">因为</span>其独特的<span style="color: black;">优良</span>，几乎<span style="color: black;">能够</span>替代传统的<span style="color: black;">没</span>创正压通气（</span><span style="color: black;">NPPV</span><span style="color: black;">）</span><span style="color: black;"></span><span style="color: black;">治疗手段，<span style="color: black;">然则</span>，<span style="color: black;">日前</span>其在急性左心衰中应用的<span style="color: black;">科研</span>不多。本<span style="color: black;">科研</span>初步探讨</span><span style="color: black;">HFNC</span><span style="color: black;">对急性左心衰<span style="color: black;">爆发</span><span style="color: black;">病人</span>的辅助治疗<span style="color: black;">功效</span>。</span></span></p><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"><span style="color: black;">1 资料和<span style="color: black;">办法</span></span></strong></p>
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<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">1.1</strong> </span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><span style="color: black;">通常</span>资料</span></strong></span></strong></span></strong></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">入选</span><span style="color: black;">2018</span><span style="color: black;">年</span><span style="color: black;">12</span><span style="color: black;">月至</span><span style="color: black;">2020</span><span style="color: black;">年</span><span style="color: black;">6</span><span style="color: black;">月间，陆河县人民医院急诊收治的急性左心衰<span style="color: black;">病人</span>共</span><span style="color: black;">72</span><span style="color: black;">例为<span style="color: black;">科研</span>对象，年龄（</span><span style="color: black;">73.61±9.47</span><span style="color: black;">）岁。入选<span style="color: black;">病人</span>按随机数字表法分为</span><span style="color: black;">2</span><span style="color: black;">组：常规治疗组</span><span style="color: black;">36</span><span style="color: black;">例，其中男女各</span><span style="color: black;">18</span><span style="color: black;">例，年龄（</span><span style="color: black;">72.16±9.77</span><span style="color: black;">）岁；</span><span style="color: black;">HFNC</span><span style="color: black;">组</span><span style="color: black;">36</span><span style="color: black;">例，其中男</span><span style="color: black;">15</span><span style="color: black;">例，女</span><span style="color: black;">21</span><span style="color: black;">例，年龄（</span><span style="color: black;">74.11±8.32</span><span style="color: black;">）岁。两组性别、年龄比较，差异<span style="color: black;">没</span>统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;">>0.05</span><span style="color: black;">）。本<span style="color: black;">科研</span>经本院医学伦理委员会<span style="color: black;">准许</span>，<span style="color: black;">科研</span>对象均签署知情同意书。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">纳入标准：（</span><span style="color: black;">1</span><span style="color: black;">）所有患符合急性左心衰诊断</span><span style="color: black;"></span><span style="color: black;">，诊断标准参照中华医学会心血管病学分会心力衰竭学组，中国医师协会心力衰竭专业委员会中华心血管病杂志编辑委员会主编的《中国心力衰竭诊断和治疗指南</span><span style="color: black;">2018</span><span style="color: black;">》中的“急性左心衰”的诊断标准；（</span><span style="color: black;">2</span><span style="color: black;">）血氧饱和度（</span><span style="color: black;">oxygen saturation, SpO2</span><span style="color: black;">）</span><span style="color: black;"><90%</span><span style="color: black;">或动脉血氧分压（</span><span style="color: black;">partial oxygen pressure, PaO2</span><span style="color: black;">）</span><span style="color: black;"><60 mmHg</span><span style="color: black;">（</span><span style="color: black;">1 mmHg=0.133 kPa</span><span style="color: black;">）。（</span><span style="color: black;">3</span><span style="color: black;">）年龄</span><span style="color: black;">>18</span><span style="color: black;">岁。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">排除标准：（</span><span style="color: black;">1</span><span style="color: black;">）急性心肌梗死<span style="color: black;">病人</span></span><span style="color: black;"></span><span style="color: black;">；（</span><span style="color: black;">2</span><span style="color: black;">）<span style="color: black;">认识</span><span style="color: black;">阻碍</span>、自主<span style="color: black;">呼气</span>微弱或停止<span style="color: black;">呼气</span>的<span style="color: black;">病人</span>；（</span><span style="color: black;">3</span><span style="color: black;">）伴有休克及上消化道大<span style="color: black;">流血</span><span style="color: black;">病人</span>；（</span><span style="color: black;">4</span><span style="color: black;">）未引流的血或气胸及心包积液、纵隔气肿<span style="color: black;">病人</span>；（</span><span style="color: black;">5</span><span style="color: black;">）心搏<span style="color: black;">呼气</span>骤停未能成功复苏的<span style="color: black;">病人</span>或<span style="color: black;">必须</span>气道插管有创机械通气的<span style="color: black;">病人</span>；（</span><span style="color: black;">6</span><span style="color: black;">）鼻腔严重阻塞的<span style="color: black;">病人</span>；（</span><span style="color: black;">7</span><span style="color: black;">）未签署知情同意书的<span style="color: black;">病人</span>。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">1.2</span></strong></span></strong></span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">诊断与治疗<span style="color: black;">办法</span></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">经鼻高流量吸氧所用</span><span style="color: black;">Fisher Paylkel AIRVO2</span><span style="color: black;">加湿器由新西兰费雪派克医疗保健<span style="color: black;">机构</span>生产。</span><span style="color: black;">HFNC</span><span style="color: black;">参数设置：<span style="color: black;">详细</span>参数<span style="color: black;">必须</span><span style="color: black;">按照</span>血气分析<span style="color: black;">调节</span>。<span style="color: black;">通常</span><span style="color: black;">病人</span>初始<span style="color: black;">调节</span>，气体流量（</span><span style="color: black;">Flow</span><span style="color: black;">）初始设置</span><span style="color: black;">30~40 L/min</span><span style="color: black;">，滴定吸入氧浓度（</span><span style="color: black;">fraction of inspiration O2, FiO2</span><span style="color: black;">）维持</span><span style="color: black;">SpO2 </span><span style="color: black;">为</span><span style="color: black;">92%~96%</span><span style="color: black;">；如<span style="color: black;">病人</span>伴有</span><span style="color: black;">II</span><span style="color: black;">型<span style="color: black;">呼气</span>衰竭，气体流量（</span><span style="color: black;">Flow</span><span style="color: black;">）初始设置</span><span style="color: black;">20~30 L/min</span><span style="color: black;">，<span style="color: black;">按照</span><span style="color: black;">病人</span>耐受性和依从性调节，<span style="color: black;">倘若</span><span style="color: black;">病人</span>二氧化碳潴留<span style="color: black;">显著</span>，流量可设置在</span><span style="color: black;">45~55 L/min</span><span style="color: black;"><span style="color: black;">乃至</span>更高，达到<span style="color: black;">病人</span>能耐受的最大流量，滴定</span><span style="color: black;">FiO2</span><span style="color: black;">维持</span><span style="color: black;">SpO2</span><span style="color: black;">在</span><span style="color: black;">88%~92%</span><span style="color: black;">。</span><span style="color: black;">HFNC</span><span style="color: black;">撤离标准：原发病<span style="color: black;">掌控</span>后<span style="color: black;">逐步</span>降低</span><span style="color: black;">HFNC</span><span style="color: black;">参数，<span style="color: black;">倘若</span>达到以下标准<span style="color: black;">就可</span><span style="color: black;">思虑</span>撤离</span><span style="color: black;"> HFNC</span><span style="color: black;">：吸气流量</span><span style="color: black;"><20 L/min</span><span style="color: black;">，且</span><span style="color: black;">FiO2<30%</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">1.4</span></strong></span><strong style="color: blue;"><span style="color: black;">观察指标</span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">测定<span style="color: black;">病人</span>治疗前、吸氧治疗前及治疗</span><span style="color: black;">2 h</span><span style="color: black;">后的呼吸频率、心率、</span><span style="color: black;">SaO2</span><span style="color: black;">、氨基末端脑钠肽前体（</span><span style="color: black;">N-terminal pro-brain natriuretic peptide, NT-proBNP</span><span style="color: black;">）、</span><span style="color: black;">PaO2</span><span style="color: black;">和动脉二氧化碳分压（</span><span style="color: black;">partial pressure of carbon dioxide, PaCO2</span><span style="color: black;">）、<span style="color: black;">必须</span>气管插管数、治疗</span><span style="color: black;">2 h</span><span style="color: black;">后舒适度评分（</span><span style="color: black;">0~5</span><span style="color: black;">分依次<span style="color: black;">暗示</span><span style="color: black;">病人</span>舒适度从最好到最差</span><span style="color: black;"></span><span style="color: black;">）。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">1.5 <span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">统计学分析</span></strong></span></strong></span></strong></span></strong></span></strong></span></strong></span></span></strong></span></strong></span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">所有统计学资料都采用</span><span style="color: black;">SPSS 22.0</span><span style="color: black;">专业统计学软件进行数据分析。计量资料以（<img src="https://mmbiz.qpic.cn/mmbiz_png/TQMJRfJDBMZHW1eSeXtdVYbTpic6oG6wYpsMGQMFB8LxB9Wx3PPpEKtxyTTNYeKQy9krGxe5EW3y2fTiaibPp5wFg/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;">）<span style="color: black;">暗示</span>，采用</span><span style="color: black;">t</span><span style="color: black;">检验。计数资料以</span><span style="color: black;"></span><span style="color: black;"><span style="color: black;">暗示</span>，用卡方（</span><span style="color: black;">χ</span><span style="color: black;">2</span><span style="color: black;">）检验。以</span><span style="color: black;">P</span><span style="color: black;"><0.05</span><span style="color: black;">为差异有统计学<span style="color: black;">道理</span>。</span></span></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">2 结 果</span></p>
</span></strong></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">2.1</strong></span><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">两组<span style="color: black;">病人</span>的<span style="color: black;">基本</span><span style="color: black;">疾患</span>比较</span></strong></span></strong></span></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">两组<span style="color: black;">病人</span>的<span style="color: black;">基本</span><span style="color: black;">疾患</span>比较，差异<span style="color: black;">没</span>统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;">>0.05</span><span style="color: black;">），详见表</span><span style="color: black;">1</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/fmBfsy8GtsACQGMaIvuZRIywCNFhVMAyCYJxuI49ic8C4jwOOgztTAUxZPwXIvYL57xL1Cab5a2nrTGnAibfELAQ/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><strong style="color: blue;">2.2 </strong><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><strong style="color: blue;"><strong style="color: blue;"><span style="color: black;"><strong style="color: blue;"><span style="color: black;">两组<span style="color: black;">病人</span>治疗疗效比较</span></strong></span></strong></strong></strong></span></strong></strong></span></strong></span></strong></span></strong></strong></strong></strong></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">常规治疗组有</span><span style="color: black;">5</span><span style="color: black;">例（</span><span style="color: black;">13.9%</span><span style="color: black;">）<span style="color: black;">必须</span>气管插管上<span style="color: black;">呼气</span>机治疗；而</span><span style="color: black;">HFNC</span><span style="color: black;">组仅</span><span style="color: black;">1</span><span style="color: black;">例（</span><span style="color: black;">2.8%</span><span style="color: black;">）<span style="color: black;">必须</span>插管，两组比较差异有统计<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.01</span><span style="color: black;">）。两组<span style="color: black;">病人</span>治疗前心率、<span style="color: black;">呼气</span>频率、平均动脉压（</span><span style="color: black;">mean arterial pressure, MPA</span><span style="color: black;">）、</span><span style="color: black;">SaO2</span><span style="color: black;">、</span><span style="color: black;">PaO2</span><span style="color: black;">、</span><span style="color: black;">PaCO2</span><span style="color: black;">和</span><span style="color: black;">NT-proBNP</span><span style="color: black;">浓度比较，差异<span style="color: black;">没</span>统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;">>0.05</span><span style="color: black;">）；治疗后</span><span style="color: black;">2 h</span><span style="color: black;">，与常规治疗组<span style="color: black;">病人</span>比较，</span><span style="color: black;">HFNC</span><span style="color: black;">组<span style="color: black;">病人</span>心率、<span style="color: black;">呼气</span>频率<span style="color: black;">显著</span>减慢，</span><span style="color: black;">NT-proBNP</span><span style="color: black;">浓度<span style="color: black;">显著</span>降低，</span><span style="color: black;">SaO2</span><span style="color: black;">及</span><span style="color: black;">PaO2</span><span style="color: black;">均<span style="color: black;">上升</span>，差异有统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.01</span><span style="color: black;">）；</span><span style="color: black;">MPA</span><span style="color: black;">有下降的趋势，<span style="color: black;">然则</span>差异<span style="color: black;">没</span>统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;">>0.05</span><span style="color: black;">），详见表</span><span style="color: black;">2</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/fmBfsy8GtsACQGMaIvuZRIywCNFhVMAyI7srPRO5ibVHBTc3gV22Bo4gkiaSJRyK7wKpWNQOwDe70GFwjpyII9bA/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;"><strong style="color: blue;">2.3 </strong></span></span><strong style="color: blue;"><span style="color: black;">两组<span style="color: black;">病人</span>舒适度的问卷评分比较</span></strong></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">治疗前，两组<span style="color: black;">病人</span>舒适度的问卷评分比较，差异<span style="color: black;">没</span>统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;">>0.05</span><span style="color: black;">）；治疗后</span><span style="color: black;">HFNC</span><span style="color: black;">组<span style="color: black;">病人</span>舒适度的问卷评分<span style="color: black;">明显</span>降于常规治疗组低，差异有统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.05</span><span style="color: black;">），详见表</span><span style="color: black;">3</span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><img src="https://mmbiz.qpic.cn/mmbiz_png/fmBfsy8GtsACQGMaIvuZRIywCNFhVMAyPzZCATVzrhlKgZqsTOINFEh1RlKCL7b8ic86w5pVYXrtSQOXczzNB6Q/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></p><span style="color: black;"><strong style="color: blue;"><span style="color: black;">
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><strong style="color: blue;"> 3 </strong><strong style="color: blue;"><span style="color: black;">结 论</span></strong></p>
</span></strong></span>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">急性左心衰竭是急诊科最<span style="color: black;">平常</span>的急<span style="color: black;">严重</span>症之一。急性左心衰竭指急性<span style="color: black;">爆发</span>或加重的左心功能<span style="color: black;">反常</span><span style="color: black;">导致</span>的心肌收缩力<span style="color: black;">显著</span>降低、心脏负荷加重，<span style="color: black;">导致</span>急性心排血血量降低、肺循环压力<span style="color: black;">忽然</span><span style="color: black;">上升</span>、<span style="color: black;">周边</span>循环阻力<span style="color: black;">增多</span>，<span style="color: black;">导致</span>肺循环充血从而<span style="color: black;">显现</span>急性肺淤血、肺水肿，以及伴组织器官灌注不足的心原性休克的一种临床<span style="color: black;">综合症</span></span><span style="color: black;"></span><span style="color: black;">。临床表现为严重<span style="color: black;">呼气</span>困难、发绀、咳粉红色<span style="color: black;">泡泡</span>样痰，强迫坐位、大汗、口唇轻微发绀、两肺底可听到水泡音等，病情危急，可<span style="color: black;">快速</span><span style="color: black;">出现</span>心源性休克、<span style="color: black;">晕倒</span>而<span style="color: black;">引起</span>死亡。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">当<span style="color: black;">病人</span><span style="color: black;">显现</span><span style="color: black;">呼气</span>困难<span style="color: black;">显著</span>伴低氧血症时，氧疗是必不可少的治疗手段。常用的氧疗<span style="color: black;">办法</span>：有创的气管插管人工<span style="color: black;">呼气</span>机<span style="color: black;">运用</span>、<span style="color: black;">没</span>创双水平气道正压<span style="color: black;">呼气</span>机辅助通气（</span><span style="color: black;">BIPAP</span><span style="color: black;">）和<span style="color: black;">连续</span>气道正压（</span><span style="color: black;">CPAP</span><span style="color: black;">）。有创的气管插管人工<span style="color: black;">呼气</span>机<span style="color: black;">因为</span>其“有创”，<span style="color: black;">常常</span>会<span style="color: black;">做为</span>最后的手段。而<span style="color: black;">没</span>创通气在心力衰竭中的应用<span style="color: black;">已然</span>得到证实</span><span style="color: black;"></span><span style="color: black;">，<span style="color: black;">然则</span>其缺点<span style="color: black;">亦</span>是<span style="color: black;">显著</span>的，<span style="color: black;">首要</span>是<span style="color: black;">必须</span>得到<span style="color: black;">病人</span>的充分<span style="color: black;">协同</span>，<span style="color: black;">因为</span>面罩与绑带对脸部皮肤<span style="color: black;">能够</span><span style="color: black;">导致</span><span style="color: black;">病痛</span>与<span style="color: black;">损害</span>，<span style="color: black;">同期</span>因密闭面罩<span style="color: black;">呼气</span><span style="color: black;">能够</span><span style="color: black;">引起</span><span style="color: black;">病人</span>的焦虑感，<span style="color: black;">同期</span>面罩<span style="color: black;">能够</span><span style="color: black;">导致</span>二氧化碳的储留等等这些都限制了其应用。近年来发展的氧疗新技术——</span><span style="color: black;">HFNC</span><span style="color: black;">，<span style="color: black;">因为</span>采用鼻吸氧<span style="color: black;">因此</span>不存在<span style="color: black;">以上</span>不足，<span style="color: black;">同期</span><span style="color: black;">因为</span>其有加温<span style="color: black;">安装</span>可<span style="color: black;">供给</span>与人体<span style="color: black;">自己</span>温度相近的气体，加湿<span style="color: black;">安装</span>能减低<span style="color: black;">病人</span>对干燥空气的<span style="color: black;">敏锐</span>度，两者均减轻了</span> <span style="color: black;"><span style="color: black;">病人</span>的不适感，<span style="color: black;">加强</span>了<span style="color: black;">病人</span>的耐受性。<span style="color: black;">另一</span>，</span><span style="color: black;">HFNC</span><span style="color: black;">与传统经鼻导管吸氧不同之处在于其<span style="color: black;">供给</span><span style="color: black;">连续</span>气道正压促进肺泡复张，改善氧合；<span style="color: black;">同期</span>；高流速气体可冲刷鼻咽部，减少鼻咽部的二氧化碳潴留，减少解剖死腔，肺泡通气量随之<span style="color: black;">增多</span>，<span style="color: black;">加强</span>肺通气的效率</span><span style="color: black;"></span><span style="color: black;">。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">此技术<span style="color: black;">日前</span><span style="color: black;">重点</span>应用于急性低氧性<span style="color: black;">呼气</span>衰竭<span style="color: black;">病人</span>的治疗</span><span style="color: black;"></span><span style="color: black;">，从原理上</span><span style="color: black;">HFNC</span><span style="color: black;">用于急性左心衰的治疗应当<span style="color: black;">特别有</span>前景，<span style="color: black;">然则</span><span style="color: black;">日前</span>所见<span style="color: black;">科研</span>文献不多</span><span style="color: black;"></span><span style="color: black;">。王亚楠等</span><span style="color: black;"></span><span style="color: black;">采用</span><span style="color: black;">HFNC 2~4 h</span><span style="color: black;">间歇性给氧</span><span style="color: black;">40 L/min</span><span style="color: black;">，结合<span style="color: black;">基本</span>的抗心力衰竭治疗，<span style="color: black;">病人</span>在短期内稳定生命征，脑钠肽浓度降低，心力衰竭症状缓解。本<span style="color: black;">科研</span>资料<span style="color: black;">表示</span>，治疗后，与常规治疗组比较，</span><span style="color: black;">HFNC</span><span style="color: black;"><span style="color: black;">病人</span>的心率及<span style="color: black;">呼气</span>频率减慢，</span><span style="color: black;"> NT-proBNP</span><span style="color: black;">浓度降低，</span><span style="color: black;">SaO2</span><span style="color: black;">及</span><span style="color: black;">PaO2</span><span style="color: black;">均<span style="color: black;">上升</span>，差异有统计学<span style="color: black;">道理</span>（</span><span style="color: black;">P</span><span style="color: black;"><0.01</span><span style="color: black;">）；<span style="color: black;">况且</span>治疗</span><span style="color: black;">2 h</span><span style="color: black;">症状就<span style="color: black;">显著</span>改善。<span style="color: black;">同期</span>，本<span style="color: black;">科研</span>数据<span style="color: black;">表示</span>，急性左心衰竭<span style="color: black;">病人</span>按指南<span style="color: black;">基本</span><span style="color: black;">药品</span>治疗<span style="color: black;">基本</span>上加用<span style="color: black;">连续</span>性</span><span style="color: black;">HFNC</span><span style="color: black;">治疗，<span style="color: black;">能够</span><span style="color: black;">显著</span>减少<span style="color: black;">病人</span><span style="color: black;">发展</span>到气管插管人工<span style="color: black;">呼气</span>机的数量，<span style="color: black;">表示</span>出<span style="color: black;">显著</span>的疗效。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><span style="color: black;">综上所述，</span><span style="color: black;"> HFNC</span><span style="color: black;">有助于急性左心衰竭<span style="color: black;">病人</span>生命征的稳定，在短期内<span style="color: black;">加强</span><span style="color: black;">病人</span>的</span><span style="color: black;">SaO2</span><span style="color: black;">及</span><span style="color: black;">PaO2</span><span style="color: black;">，降低</span><span style="color: black;">NT-proBNP</span><span style="color: black;">浓度，改善急性左心衰竭<span style="color: black;">病人</span>的短期症状。当然，其确切的疗效有待于进一步的大规模多中心<span style="color: black;">科研</span>证实。</span></span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;">参考文献（略）</span></p>
<p style="font-size: 16px; color: black; line-height: 40px; text-align: left; margin-bottom: 15px;"><span style="color: black;"><img src="https://mmbiz.qpic.cn/mmbiz_png/fmBfsy8GtsCyeGqO7icN9rEFPS5vQaDsHCdGYPw8c8hQ2NXRWGhlFo6uV0n9oxXm2AoY1LgbNoNHBO7trFGMLiag/640?wx_fmt=png&tp=webp&wxfrom=5&wx_lazy=1&wx_co=1" style="width: 50%; margin-bottom: 20px;"></span></p>
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