经鼻高流量湿化氧疗治疗先天性心脏病术后呼吸衰竭的有效性研究  

Efficacy of Humidified High Flow Nasal Cannula for Respiratory Failure after Ventilator Weaning in Post-operative Children with Congenital Heart Disease

作　　者：崔彦芹 周娜 王燕飞 马力 陈伟丹 杨盛春 崔虎军 陈欣欣 

机构地区：[1]广州市妇女儿童医疗中心心脏中心,广东广州510623

出　　处：《中国呼吸与危重监护杂志》2012年第3期231-234,共4页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家自然科学基金(编号:81100233)

摘　　要：目的探讨在先天性心脏病术后撤离呼吸机后出现呼吸衰竭的患儿中应用经鼻高流量湿化氧疗系统(HHFNC)的有效性。方法回顾性分析2011年1月1日至2011年8月31日期间在广州市妇女儿童医疗中心行先天性心脏病手术,术后脱离呼吸机后出现呼吸衰竭的33例患儿,其中男23例,女10例;年龄3 d～36月,平均(7.8±8.4)月;体重2.2～19.6 kg,平均(6.6±3.6)kg。将33例患儿分为普通吸氧组(22例)和HHFNC组(11例)。比较先天性心脏病术后患儿撤离机械通气后应用HHFNC前后的症状、SpO2、PaO2、PaCO2改善程度,以及再次气管插管机械通气比例、ICU停留时间、住院时间等指标。结果 HHFNC组与普通吸氧组的住院时间、ICU停留时间、机械通气时间及术后合并感染率比较差异均无统计学意义(P>0.05)。但HHFNC组的二次插管率显著低于普通吸氧组(9.1%比68.2%,P<0.05)。HHFNC组患儿应用HHFNC后不同时间点(1 h、12 h、24 h、撤离HHFNC前、撤离HHFNC 1 h后)分别与HHFNC前比较SpO2及PaO2升高,PaCO2降低,差异均有统计学意义(P<0.05)。结论先天性心脏病术后撤离呼吸机后出现呼吸衰竭的患儿应用经鼻高流量湿化氧疗后,可有效、快速改善氧合及减轻二氧化碳潴留,减少二次气管插管的可能性。Objective To explore the efficacy of humidified high flow nasal cannula（HHFNC） for respiratory failure after ventilator weaning in post-operative newborns and infants with congenital heart disease.Methods From Janua ry 2010 to August 2010,33 newborns and infants [（7.8±8.4）months,range 3 day s to 36 months;weight（6.6±3.6）kg,range 2.2 to 19.6 kg] were treated with H HFNC（22 cases） and routine oxygen therapy（11 cases） for respiratory failu re following ventilator weaning after operation of congenital heart disease.Sy mptoms,blood oxygen saturation（SpO2）,partial pressure of oxygen（PaO2）,pa rtial pressure of carbondioxide（PaCO2）,incidence rate of re-intubation,d ura tion of ICU,and hospital stay were assessed and compared between the HHFNC grou p and the routine oxygen therapy group.Results There were no statistical sig nificance in the duration of ICU,hospital stay,duration of mechanical ventil ation,or infection rate between the HHFNC group and the routine oxygen therapy group（P0.05）.But the incidence rate of re-intubation was lower in the HHFN C group than that in the routine oxygen therapy group.Meanwhile SpO2 and Pa O2 increased and PaCO2 decreased significantly in the HHFNC group（P0.05）.Conclusion HHFNC shows a clinical improvement rapidly and effici ently in preventing respiratory failure after ventilator weaning in post-operative newborns and in fants with congenital heart disease.

关 键 词：先天性心脏病 呼吸衰竭 经鼻高流量氧疗 有效性 

分 类 号：R726.5[医药卫生—儿科]