经鼻高流量氧疗在ICU拔除气管导管后患者的序贯应用  

Sequential application of nasal high-flow oxygen therapy after extubation in patients of intensive care unit

作　　者：惠智艳[1] 袁伟伟[1] 张旭 沙海旺[1] HUIZhiyan;YUAN Weiwei;ZHANG Xu;SHA Haiwang(Department of Critical Care Medicine,Yan'an University Affiliated Hospital,Yan'an,Shaanxi,716000,China)

机构地区：[1]延安大学附属医院重症医学科,陕西延安716000

出　　处：《临床急诊杂志》2020年第2期111-114,共4页Journal of Clinical Emergency

摘　　要：目的:探讨重症监护病房(ICU)急性呼吸衰竭患者撤机拔除气管导管后高流量氧疗序贯治疗的临床疗效。方法:选取2018-01—2019-06期间我院中心ICU收治的患者156例,行自主呼吸试验(SBT)试验后符合拔管程序,采用随机数字法将患者分为高流量组和常规组,分别予拔管后高流量氧疗序贯治疗和储氧面罩吸氧。比较两组患者治疗后24 h氧合指数(PaO2/FiO2)、动脉血二氧化碳分压(PaCO2)、呼吸频率、心率以及临床结局,包括48 h再插管率,ICU住院时间、总住院时间及28 d病死率。结果:高流量组70例,常规组86例,高流量组拔管后24 h PaO2/FiO2高于常规组,呼吸频率及心率低于常规组(P<0.05);两组PaCO2比较,差异无统计学意义(P>0.05)。高流量组拔管后48 h再插管率低于常规组,总住院时间及28 d病死率低于常规组(P<0.05);两组ICU住院时间比较,差异无统计学意义(P>0.05)。结论:高流量氧疗较储氧面罩吸氧能改善ICU患者拔管后的氧合指数,改善呼吸和循环,且可降低撤机拔管后48 h再插管率和总住院时间,降低28 d病死率。Objective: To investigate the clinical efficacy of sequential treatment of high-flow oxygen therapy in patients with acute respiratory failure after extubation in intensive care unit(ICU). Method: A total of 156 patients with endotracheal intubation after the SBT trial admitted to the ICU of Yan’an University affiliated Hospital from January 2018 to July 2019 were enrolled. The patients were divided into high-flow group and routine group randomly, respectively receiving high flow nasal cannula(HFNC) therapy and storage mask oxygen inhalation sequentially after extubation. The oxygenation index(PaO2/FiO2), arterial blood carbon dioxide partial pressure(PaCO2), respiratory rate and heart rate were compared between two groups 24 hours after extubation. Clinical outcomes between the two groups were also compared, including 48 h reintubation rate, ICU stay, total hospital stay, and 28-day mortality. Result: There were 70 cases in the high-flow group and 86 cases in the conventional group. 24 h after extubation in high-flow group, the oxygenation index(PaO2/FiO2) was higher, the respiratory rate and heart rate were lower compared to those in the conventional group(P<0.05), and the PaCO2 had no statistical difference between two groups(P>0.05). 48 h after extubation in high-flow group, the re-intubation rate, the hospital stay and 28-day mortality were lower than those in the conventional group(P<0.05), and the ICU stay had no statistical difference between two groups(P>0.05). Conclusion: High-flow oxygen therapy can improve the oxygenation index after extubation in ICU, improve respiratory and circulation, reduce the re-intubation rate of 48 hours and the hospital stay, and reduce the 28-day mortality rate.

关 键 词：经鼻高流量氧疗 序贯治疗 氧合指数 

分 类 号：R563.8[医药卫生—呼吸系统]