高流量氧疗与无创通气用于胸部大术后呼吸功能不全的临床疗效比较  

Comparison of the Clinical Effect on the Respiratory Insufficiency after Thoracic Surgery between High Flow Oxygen Therapy and Noninvasive Ventilation

作　　者：陶伟民 梅运清[3] 周海军[2] 江帆[2] 徐珂嘉 TA O Wei-min MEI Yan-qing ZHOU Hai-jun JIANG Fan XU Ke-jia(Tongji University School of medicine, Shanghai, 200092 China 2 Department of thoracic and cardiovascular surger , Shanghai, 200065, China Shanghai tongren Hospital（SICU Tongren Hospital, Shanghai Jiaotong University School of Medicine）, Shanghai, 200335)

机构地区：[1]同济大学医学院,上海200092 [2]上海市同仁医院(上海交通大学医学院附属同仁医院)SICU,上海200335 [3]同济大学附属同济医院心胸外科,上海200065

出　　处：《现代生物医学进展》2016年第35期6839-6841,6807,共4页Progress in Modern Biomedicine

摘　　要：目的:探讨高流量氧疗与无创通气用于胸部大术后呼吸功能不全的临床疗效及安全性。方法:将62例接受胸部大术后发生急性呼吸功能不全的患者随机分为氧疗组和经鼻持续气道正压通气(NCPAP)组,每组各31例。两组分别给予高流量氧疗和NCPAP,比较两组患者的血气指标、临床疗效及并发症的发生情况。结果:通气后2 h,氧疗组患者的pH、PaO_2、SpO_2明显上升,且明显高于NCPAP组(P<0.05);通气后12 h后,两组pH、PaO_2、SpO_2比较差异均无统计学意义(P>0.05);与NCPAP组比较,氧疗组吸痰次数、痰痂形成比例明显减少,痰液粘稠度也明显减轻(P<0.05);两组住院时间、ICU停留时间、辅助通气时间比较差异均无统计学意义(P>0.05);氧疗组气漏、呼吸道粘膜出血、肺部感染的发生率均显著低于NCPAP组(P<0.05)。结论:高流量氧疗在改善胸部大术后呼吸功能不全的动脉血气方面临床疗效与NCPAP相当,但其对气道损伤小,可促进痰液排出,降低感染的发生。Objective： To compare the clinical effects and safety on the respiratory insufficiency after thoracic surgery between high flow oxygen therapy and noninvasive ventilation. Methods： 62 cases of patients with respiratory insufficiency after thoracic surgery were randomly divided into two groups. Oxygen therapy group and NCPAP group was given high flow oxygen therapy, nasal continuous positive airway pressure, respectively. The blood-gas, clinical effects and complications were observed and compared. Results： After ventilation for 2 h, the pH, PaO2, SpO2 in oxygen therapy group were remarkably improved and significantly higher than those in the NCPAP group （P〈0.05）. There was no significant difference in these indicators after ventilation for 12 h between two groups（P〉0.05）. Compared with NCPAP group, the time of sputum suction, percentage of sputum crust in oxygen therapy group decreased significantly, the viscosity of sputum also significantly decreased （P〈0.05）. There was no statistically significant difference in the hospital stay, ICU stay, assisted ventilation time between two groups （17〉0.05）. The incidence of air leak, respiratory tract mucous membrane bleeding, pulmonary infection in oxygen therapy group were significantly lower than those in the NCPAP group （P〈0.05）. Conclusions： High flow oxygen therapy has similar equal clinical effect to NCPAP on improving the arterial blood gas of patients with respiratory insufficiency after thoracic surgery, but had advantage on less airway damage, discharge of sputum, lower the occurrence of infection.

关 键 词：高流量氧疗 经鼻持续气道正压通气 胸外科手术 急性呼吸功能不全 

分 类 号：R655[医药卫生—外科学] R605[医药卫生—临床医学]