摘要：
Objective To explore the effect of noninvasive ventilation (NIV) with helmet or facial mask on clinical efficacy, tolerability, and prognosis in patients with acute respiratory failure. Methods Fifty patients with acute respiratory failure according to the inclusion criteria were recruited from January 2018 to July 2018 in Emergency Intensive Care Unit of the First Affiliated Hospital of Zhengzhou University. Included patients were randomly allocated into the helmet group or facial mask group. Based on conventional drug therapy, pressure support mode was performed with the interface of the helmet or facial mask. Oxygenation index, arterial carbon dioxide partial pressure, and respiratory rates were measured before and after the treatment, and the data were compared and analyzed by the repeated measures ANOVA. Tolerance score, complication rate, tracheal intubation rate, and mortality rate were recorded at each observation time point of the two groups. Results The oxygenation index before NIV, at 4 h and at the end of NIV treatment of the helmet group were significantly increased from (160.29±50.32) mmHg to (249.29±83.47) mmHg and (259.24±87.09) mmHg; the oxygenation index of the facial mask group were increased from (168.63±38.63) mmHg to (225.00±74.96) mmHg and (217.69±77.80) mmHg, and there was no significant difference within the two groups (P 0.05). Patients in the helmet was better tolerated than those in the facial mask group [ratio of good tolerance 96％ (24/25) vs 56％ (14/25) (P = 0.001) and fully tolerance 80％ (20/25) vs 36％ (9/25) (P =0.002)] and had less complications (1/25 vs 10/25, P = 0.002). 84％ patients in the helmet group and 76％ patients in the facial mask group were successfully weaned and discharged after NIV treatment (P =0.480). Conclusions Similar clinical efficacy in improving blood gas exchange and relieving dyspnea were observed in the helmet group and the facial mask group in patients with acute respiratory failure. However, the helmet is better tolerant, and had lower complication rate, which is especially suitable for patients with chest trauma combined with facial injuries.%目的 探讨头罩无创通气(noninvasive ventilation,NIV)与面罩NIV在急性呼吸衰竭患者中的临床疗效、耐受性和预后情况.方法 选择郑州大学第一附属医院急诊重症监护室2018年1月至2018年7月收住的符合纳入标准的50例急性呼吸衰竭患者.采用随机(随机数字法)对照方法分为头罩NIV组和面罩NIV组,在常规药物治疗的基础上均采用无创压力支持模式,通过呼吸回路使头罩或面罩与呼吸机紧密连接.观察两组患者治疗前后的氧合指数、动脉二氧化碳分压、呼吸频率等指标并应用重复测量方差分析方法对比分析,记录两组患者各观察点的耐受评分,并发症发生率、气管插管率及病死率.结果 与治疗前比较,头罩组和面罩组NIV 4 h、结束时氧合指数分别从(160.29±50.32)mmHg和(168.63±38.63)mmHg显著升高至(249.29±83.47)mmHg和(225.00±74.96)mmHg、(259.24±87.09)mmHg和(217.69±77.80)mmHg,呼吸频率分别从(27.60±7.64)次/min和(24.68±6.14)次/min明显降低至(17.92±4.55)次/min和(20.36±4.25)次/min、(16.88±3.90)次/min和(19.68±3.34)次/min,差异均具有统计学意义(P0.05).与面罩NIV组相比,头罩NIV组具有较好的耐受性[良好耐受率96％(24/25)比56％(14/25)(P=0.001),完全耐受率80％(20/25)比36％(9/25)(P=0.002)],较少的并发症1/25比10/25(P=0.002).两组成功脱机后好转转出率达84％ 和76％(P=0.480).结论 头罩NIV与面罩NIV相比,在急性呼吸衰竭患者中改善血气交换、缓解呼吸困难的临床疗效相似,但前者具有更高的耐受率、更低的并发症发生率,对于胸部创伤合并颌面部损伤患者尤为适用.
