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《Chinese Journal of Critical Care Medicine》 2019-09
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Applied study on the treatment of AIDS and acute hypoxemic respiratory failure by humidified high flow nasal cannula

Zhang Le;Tang Li-bin;Xia Jia-wei;Li Yun-zhen;Han Liu-xin;Lyu Zheng-xuan;Department of ICU,the 3rd People's Hospital of Kunming,Dali University;  
Objective To explore the applied efficacy of humidified high flow nasal cannula(HHFNC) on treatment of acquired immunodeficiency syndrome(AIDS) and acute hypoxemic respiratory failure(AHRF).Methods Sixty-five cases of AIDS and AHRF in adults,who received treatment in the Third People's Hospital of Kunming and did not meet the indications of invasive mechanical ventilation were analyzed.According to the treatment method,it was divided into humidified high flow nasal cannula group(HHFNC group),noninvasive positive respiratory pressure ventilation group(NIPPV group),and ordinary oxygen group(control group).The main symptoms and signs disappeared in patients with time,length of hospital stay and tolerance,comfort,leak rate,the incidence of abdominal distension of each groups and the treatment effect of each groups were compared.Results①The HHFNC group and NIPPV group had significantly shorter respiratory difficulties [(2.1±0.8)d,(2.2±0.7)d],cyanosis disappearance time [(1.7±0.5)d,(1.8±0.6)d] and hospitalization time[(14.6±0.9) d,(15.1±0.8) d] than the control group [(4.9±1.1)d,(4.2±0.9)d,(22.3±1.7)d],the difference was statistically significant(P 0.05).②HHFNC group had better tolerance(1.5±0.5)scores and comfort(1.8±0.5)scores than NIPPV group [(2.7±0.9)scores,(3.1±0.9)scores]and control group [(2.1±0.6) scores,(2.9±0.8)scores],and the control group(2.1±0.6) scores had better tolerance than NIPPV group(2.7±0.9)scores with statistically significant differences(P0.05).HHFNC group [0(0),1(5.0%)] and control group [0(0),1(4.0%)] had lower air leakage rate and abdominal distension rate than NIPPV group [7(35.0%),9(45.0%)],and the difference was statistically significant(P0.05).③Compared with the control group,RR and SpO_2,Pa02,Pa02/Fi02 improved more after treatment in HHFNC group and NIPPV group at various time points,and the difference was statistically significant(P 0.05).There were differences in the improvement of RR,compared with NIPPV group [(26.3±4.7) beats/min,(25.9±4.1) beats/min],HHFNC group [(23.1±3.4) beats/min,(21.6±2.7) beats/min] showed more significant improvement in RR at 12 h and 24 h after treatment,and the difference was statistically significant(P 0.05).④HHFNC group[16(80.0%),2(10.0%)] and NIPPV group [15(75.0%),3(15.0%)] had higher therapeutic efficiency than the control group [14(56.0%),9(36.0%)],lower invasive mechanical ventilation rate(P0.05).Conclusion The efficacy of HHFNC in the treatment of AIDS and AHRF is better than that of ordinary oxygen therapy.Compared with non-invasive ventilators and conventional oxygen therapy,it has better comfort and tolerance,and the incidence of abdominal distension and leak rate is lower.Reducing the RR in the early treatment has significant advantages.It is a kind of noninvasive respiratory support technology that is suitable for promotion.
【Fund】: 云南省教育廳科學研究基金資助項目(2019J0788);; 云南省重點專科建設基金資助項目(云衛醫發[2017]15號);; 重癥感染性疾病機械通氣技術中心基金資助項目(2019-SW(技)-19)
【CateGory Index】: R512.91;R563.8
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