HFNC与NPPV对于心外科术后低氧血症患者的疗效研究  

Effects of high-flow nasal cannula and noninvasive positive pressure ventilation for the hypoxemia following cardiac surgery

作　　者：杨毅[1] 刘楠[1] 候晓彤[1] 孙立忠[2] 王红[1] 金祺[1] 

机构地区：[1]首都医科大学附属北京安贞医院北京市心肺血管疾病研究所心外科危重症中心,北京100029 [2]首都医科大学附属北京安贞医院心脏外科北京市心肺血管疾病研究所北京市大血管疾病诊疗研究中心,北京100029

出　　处：《首都医科大学学报》2016年第5期664-671,共8页Journal of Capital Medical University

基　　金：国家卫生和计划生育委员会-公益性行业科研专项项目(201402009)~~

摘　　要：目的比较研究新型无创通气方式——经鼻高流量氧疗（high-flow nasal cannula,HFNC）与传统无创正压通气（noninvasive positive pressure ventilation,NPPV）2种呼吸治疗方式在心外术后低氧血症方面的治疗效果。方法选择2016年2月1日至2016年7月1日,首都医科大学附属北京安贞医院行心脏外科手术入住心外危重症中心,术后拔除气管插管之后24 h内发生低氧血症（hypoxima）,符合纳入标准的40例患者,采用数字表法随机分为2组,应用HFNC或NPPV进行呼吸治疗[患者年龄（52.9±7.8）岁vs（53.8±8.9）岁,P〉0.05;男性性别比65%vs 70%,P〉0.05;术后基础急性生理学和慢性健康状况评分系统Ⅱ（APACHE II）评分（9.4±2.2）分vs（9.3±2.2）分,P〉0.05]。起始参数设置：HFNC：流量45 L/min,温度37℃,吸氧浓度（Fi O2）60%～80%;NPPV：吸气压（inspiratory pressure,IPAP）10～12 cm H_2O（1cm H_2O=0.098 k Pa）,呼气压（expiratory pressure,EPAP）4～6 cm H_2O,FiO_2 60%～80%,吸呼比（radio of inspiration and expiration,I∶E）为1∶1.5～2.0,根据临床疗效和患者耐受程度等逐渐调节。对比研究2种方法治疗方法在不同时间点（治疗后2 h、8 h、24 h、结束时）的呼吸、循环等方面情况,以及并发症、再次插管率、气切率、监护室（intensive care unit,ICU）时间、住院时间等方面的差异。结果 2组患者分别接受HFNC与NPPV 2种方法治疗,发现HFNC在改善氧合指数（PaO_2/FiO_2）、降低PaCO_2均较NPPV组效果明显（P〈0.05）;呼吸频率（respiratory rate,RR）、心率（heart rate,HR）在HFNC组均较NPPV组有明显下降（P〈0.05）。治疗结束时HFNC组较NPPV组胃肠胀气（0vs 20%,P〈0.05）、不耐受（0 vs 25%,P〈0.05）等主要合并症发生率为低;HFNC治疗时间明显较NPPV组为短（P〈0.05）;再次插管、气管切开发生率两组比较差异无统计学意义（P〉0.05）;重症监护室（intensive care unit,ICU）时间、住院时间�Objective To assess the efficacy of the high-flow nasal cannula（ HFNC） and noninvasive positive pressure ventilation（ NPPV） in hypoxemia following extubation after cardiac surgery,and the effect on re-intubation rate,intensive care unit（ ICU） time and hospital stay. Methods Forty patients recovering from the cardiac surgery operation in the Center for Cardiac Intensive Care,Beijing Anzhen Hospital between Feb 1,2016 and July 1,2016,and meet the inclusion criterion after extubation,were investigated. The patients were random divided into two groups（ simple randomization with Rand A1. 0 software）,each group contained 20 patients： HFNC vs NPPV（ age of year 52. 9 ± 7. 8 vs 53. 8 ± 8. 9,P〉0. 05; male 65% vs 70%,P〉0. 05; APACHE II 9. 4 ± 2. 2 vs 9. 3 ± 2. 2,P〉0. 05）. Initial settings： HFNC： the flux was 45 L / min,temperature 37℃,and the fraction of inspired oxygen（ Fi O2） was adjusted to 60%- 80%; NPPV：inspiratory pressure（ IPAP） of 10- 12 cm H2O（ 1cm H2 O = 0. 098 k Pa）,expiratory pressure（ EPAP） of 4- 6 cm H2 O,Fi O260%-80%,radio of inspiration and expiration（ I∶ E） 1∶ 1. 5- 2. The parameters of setting were adjusted with therapeutic effect and tolerance of patients. Make a comparison with the two groups in the clinical effect at different times（ 2 h,8 h,24 h and end of therapy）,and to compare their complications,re-intubation rate,tracheotomy rate,intensive care unit（ ICU） duration and hospitalization time. Results Compared to NPPV treatment group Pa O2/ Fi O2 was higher in the HFNC group（ P〈0. 05）; and Pa CO2 was lower in the HFNC group（ P〈0. 05）; respiratory rate（ RR） and heart rate（ HR） were lower in the HFNC group（ P〈0. 05）. The main complications such as flatulence（ 0 vs 20%,P〈0. 05） and intolerance（ 0 vs 25%,P〈0. 05） were less in the HFNC group. Therapeutic time was shorter in the HFNC; but no significant difference showed in the re-intubation rate,tracheotomy rate,ICU duration and hospitalization tim

关 键 词：经鼻高流量氧疗 无创正压通气 低氧血症 心脏外科 

分 类 号：R654.2[医药卫生—外科学]