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目的 观察比较经鼻高流量氧疗（high flow nasal cannula,HFNC）与无创正压通气（noninvasive positive pressure ventilation,NPPV）对重症监护病房（intensive care unit,ICU）老年心力衰竭患者生理指标及临床结局的影响。方法 回顾性连续选择2023年3月至12月首都医科大学附属北京安贞医院急诊ICU收治的老年心力衰竭患者73例，根据历史实际接受治疗方案分为HFNC组34例和NPPV组39例。比较两组治疗前及治疗后1 d生命体征（呼吸频率、心率）及动脉血乳酸水平，以及治疗前及治疗后7 d通过心脏彩色多普勒超声测量左心室射血分数（left ventricular ejection fraction,LVEF）。记录治疗期间不耐受事件，对ICU住院时间、总住院时间及28 d全因死亡率等结局指标进行统计分析。结果 HFNC组和NPPV组治疗后1 d呼吸频率较治疗前均显著下降（P<0.05）,HFNC组呼吸频率差值显著低于NPPV组[-1(-7,2)次/min vs 0(-2,3)次/min,P<0.05]。治疗后7 d HFNC组LVEF差值显著低于NPPV组[-5(-10,2)%vs2(-3,15)%,P<0.01]。HFNC组与NPPV组乳酸改善（64.7%vs 51.3%）、ICU住院时间[13(11,16)d vs 13(10,23)d]及28 d全因死亡（11.8%vs 17.9%）比例比较，均差异无统计学意义（P>0.05）。结论 HFNC更利于平复心力衰竭患者情绪、提供有效氧供及快速改善呼吸频率；NPPV在改善心功能上更具优势，HFNC可作为不耐受NPPV患者的有效替代氧疗方式，以确保临床治疗连续性与患者舒适度。
Abstract：Objective To observe and compare the efficacy of high-flow nasal cannula(HFNC) and noninvasive positive pressure ventilation(NPPV) on physiological parameters and clinical outcomes in elderly heart failure(HF) patients in the intensive care unit(ICU). Methods A retrospective analysis was conducted on 73 elderly HF patients admitted to the Emergency ICU of Beijing Anzhen Hospital from March to December 2023. According to the actual treatment regimens received, they were divided into an HFNC group(n=34) and an NPPV group(n=39). Vital signs(respiratory rate, heart rate) and arterial blood lactate levels, as well as left ventricular ejection fraction(LVEF) measured by color Doppler echocardiography were compared between the two groups before treatment and at 1 d after treatment. Intolerance events during treatment were recorded, and outcome indicators such as ICU length of stay, total length of stay, and 28-day all-cause mortality were statistically analyzed. Results One day post-treatment, the respiratory rate decreased in both groups compared to pre-treatment levels(P<0.05). The HFNC group showed a significantly lower difference in respiratory rate compared to the NPPV group[-1(-7, 2) breaths/min vs 0(-2, 3) breaths/min, P<0.05]. 7 days after treatment, the LVEF difference in the HFNC group was significantly lower than that in the NPPV group[-5(-10, 2)% vs 2(-3, 15)%, P<0.01]. There were no statistically significant differences between the HFNC group and NPPV group in terms of lactate improvement(64.7% vs 51.3%), ICU length of stay[13(11, 16)d vs 13(10, 23)d], and 28-day all-cause mortality(11.8% vs 17.9%). Conclusion HFNC stabilizes mood, ensures oxygen supply and improves respiratory rate faster. NPPV better enhances cardiac function. For NPPV-intolerant patients, HFNC is an effective alternative oxygen therapy, ensuring continuity of clinical treatment and patient comfort.
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基本信息:
中图分类号:R541.6
引用信息:
[1]刘璐,李雅敏,贺晓楠.经鼻高流量氧疗与无创正压通气治疗重症监护病房老年心力衰竭患者的疗效对比[J].中华老年心脑血管病杂志,2026,28(09):1225-1228.
基金信息:
国家自然科学基金（12371527,62272327）
2026-09-15
2026-09-15