高流量氧疗与标准氧疗对免疫功能低下AHRF患者的生存获益分析

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摘要目的探讨高流量氧疗与标准流量氧疗对免疫功能低下的急性低氧血症呼吸衰竭（AHRF）患者的生存获益差异。方法选取2017年5月~2019年3月上海市第一人民医院、上海市东方医院3个重症监护室（ICU）72例患者。根据入院的月份采取奇偶分配法，分为高流量组和标准流量组，每组36例。高流量组使用氧疗装置提供氧气，标准流量组可使用任何装置或装置组合提供氧气，共观察28 d。比较两组28 d总死亡率，ICU内死亡、ICU外死亡人数，有创通气人数，ICU获得性感染人数，ICU住院时间、总住院时间；分析两组随机化因素对死亡率和28 d累积有创机械通气率的风险比；事后分析使用插管患者的模型和子集分析。结果两组28 d总死亡人数、ICU内死亡人数、ICU外死亡人数、有创通气人数、总住院时间比较，差异无统计学意义（P ＞ 0.05）；高流量组ICU获得性感染低于标准流量组，ICU住院时间短于标准流量组，差异有统计学意义（P ＜ 0.05）。随机化因素对28 d死亡率差异无统计学意义（P ＞ 0.05），对累积有创机械通气率差异有统计学意义（P < 0.05）。结论在免疫功能低下的AHRF患者中，与标准流量氧疗比较，高流量氧疗并未显著降低28 d死亡率和累积有创机械通气率，但可以在短期内改善患者的氧合指标(PaO2/FIO2)，缩短ICU内住院时间，降低ICU内获得性感染率。

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	张明明1 张琦1 舒勤琴1 王薇2 张星2▲

关键词 ：高流量氧疗, 急性低氧血症呼吸衰竭, 院内获得性感染

Abstract：Objective To investigate the survival benefit between high flow oxygen therapy and standard flow oxygen therapy for patients with low immune function AHRF. Methods From May 2017 to March 2019, a total of 72 cases in 3 intensive care units of Shanghai General Hospital and Shanghai Oriental Hospital were selected. According to the month of admision, the parity distribution method was adopted, they were divided into the high flow group and the standard flow group, with 36 cases in each group. The high-flow group was provided by oxygen therapy device and the standard flow group was provided by any device or combination of devices. All patients were observed for 28 d. The total mortality of 28 d, the number of deaths in and out of the ICU, the number of invasive ventilation, the number of acquired infections in the ICU, the length of stay in the ICU and the total length of stay in hospital were compared between the two groups. The risk ratio of randomized factor to mortality and cumulative invasive mechanical ventilation rate on 28 d were analyzed. Post-hoc analysis used a model and subset analysis of intubated patients. Results There were no statistically significant differences in terms of total death of 28 d, in and out of ICU death, invasive ventilation, and total hospital stay between the two groups (P > 0.05). The ICU acquired infection in the high flow group was lower than that in the standard flow group, and the length of stay in the ICU was shorter than that in the standard flow group, with statistically significant differences (P < 0.05). Randomization factors had no statistical significance on the mortality rate of 28 d (P > 0.05), and had a statistically significant effect on the cumulative invasive mechanical ventilation rate (P < 0.05). Conclusion Compared with standard flow oxygen therapy, high flow oxygen therapy does not significantly reduce the mortality rate and cumulative invasive mechanical ventilation rate in 28 d, but can improve the oxygenation index (PaO2/FIO2) in a short time, shorten the hospitalization time in ICU and reduce the rate of acquired infection in ICU.

Key words： High flow oxygen therapy Acute hypoxemic respiratory failure Nosocomial acquired infection

基金资助:上海交通大学医学院科技基金项目（JYH1605）。

通讯作者: ▲通讯作者

引用本文:

张明明1 张琦1 舒勤琴1 王薇2 张星2▲. 高流量氧疗与标准氧疗对免疫功能低下AHRF患者的生存获益分析[J]. 中国医药导报, 2020, 17(1): 110-114.
ZHANG Mingming1 ZHANG Qi1 SHU Qinqin1 WANG Wei2 ZHANG Xing2▲. Survival benefit analysis of high flow oxygen therapy and standard oxygen therapy for patients with low immune function AHRF. 中国医药导报, 2020, 17(1): 110-114.

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http://www.yiyaodaobao.com.cn/CN/ 或 http://www.yiyaodaobao.com.cn/CN/Y2020/V17/I1/110

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