急性呼吸衰竭患者拔管后序贯经鼻高流量通气的疗效分析  

Efficacy analysis of sequential nasal high flow oxygen after extubation in patients with acute respiratory failure

作　　者：张焕然 浦其斌[1] 张京臣 刘鑫 陆远强[1] Zhang Huanran;Pu Qibin;Zhang Jingchen;Liu Xin;Lu Yuanqiang(Department of Emergency： Zhejiang University School of Medicine Affiliated First Hospital, Hangzhou, China 310003)

机构地区：[1]浙江大学医学院附属第一医院急诊科,杭州310003

出　　处：《中华急诊医学杂志》2018年第4期373-378,共6页Chinese Journal of Emergency Medicine

基　　金：浙江省中医药（中西医结合）重点学科建设项目（2017-XK-A36）

摘　　要：目的探讨急性呼吸衰竭（简称呼衰）患者拔管后序贯经鼻高流量通气的临床疗效。方法回顾性选取2017年1月至2017年12月期间浙江大学医学院附属第一医院收治的重症肺炎导致急性呼吸衰竭患者69例，按照拔管后不同通气方式分为经鼻高流量通气组（HFNCO组）（32例）及无创机械通气组（NIV组）（36例）进行序贯治疗，首先对HFNCO组患者拔管前后呼吸循环指标（PaO2、PaCO2、pH值、乳酸值、氧合指数、HR、RR、LVEF）进行自身对照研究，其次对比分析HFNCO组及NIV组患者拔管前后呼吸循环指标（PaO2、PaCO2、pH值、乳酸值、氧合指数、HR、RR）、治疗结束时终点事件／合并症（谵妄、腹泻、再插管、拔管后ICU停留时间）等临床指标。结果HFNCO组患者拔管后1h、6h、12h和24h的PaO2、PaCO2、pH值、乳酸值等与拔管前1h比较，差异均无统计学意义（均P〉0．05）；拔管后患者氧合指数升高，HR、RR有所下降，差异均具有统计学意义（均P〈0．05）；拔管后LVEF较拔管前略高（0．59±0．09比0．60±0．09），差异无统计学意义（P〉0．05）。拔管后1h、6h、12h和24h时，HFNCO组及NIV组患者的PaO2、PaCO2、pH值、乳酸值等结果比较，差异均无统计学意义（均P〉0．05）.HFNCO在改善患者拔管后氧合指数方面作用较NPV组效果明显（P〈0．05）；两组患者拔管前HR、RR均处于偏高或正常偏高水平，在HFNCO组较NPV组降低HR、RR效果更好（P〈0．05）。HFNCO组患者腹泻发生率（33．33％比38．89％）、再插管率（6．1％比13．9％）低于NIV组（38．89％），但差异无统计学意义（均P〉0．05）。HFNCO组患者谵妄发生率（18．18％比41．67％）、拔管后ICU停留时间（2．00比3．50），差异有统计学意义（均P〈0．05）。结论对于急性呼衰患者机械通气拔管后，序贯给予HFNCO与NIV均能提供稳定有效的氧疗支持；相对于NIV�Objective To investigate the clinical efficacy of sequential nasal flow ventilation after extubation in patients with acute respiratory failure （referred to as respiratory failure）. First of all, before and after extubation in HFNCO group, the respiratory parameters （PaO2, PaCO2, pH, lactic acid value, oxygenation index, HR, RR and LVEF） were compared with each other. The circulatory parameters （PaO2, PaCO2, pH, lactate, oxygenation index, HR, RR）, clinical outcomes at the end of treatment / comorbidities （delirium, diarrhea, reintubation, ICU stay after extubation）. Methods PaO2, PaCO2, pH value, lactate value at 1 h, 6 h, 12 h and 24 h after extubation in HFNCO group were not significantly different from those before extubation （all P〉 0.05） （P 〈0.05）. The LVEF of patients after extubation was slightly higher than that before extubation （0.59 ± 0.09 vs. 0.60 ±0.09）, and the difference was not statistically significant Significance （P〉 0.05）. PaO2, PaCO2, pH and lactate value in HFNCO group and NIV group at 1 h, 6 h, 12 h and 24 h after extubation showed no significant difference （all P〉 0.05）. The effect of HFNCO on improving the oxygenation index after extubation was better than that of NPV group （P 〈0.05）. HR and RR before extubation were higher or higher in HFNCO group than those in NPV group lower HR, RR better （P 〈0.05）. The incidence of diarrhea （33.33% vs. 38.89%） and reintubation rate （6.1% vs 13.9%） in HFNCO group were lower than those in NIV group （38.89%）, but the difference was not statistically significant （all P〉 0.05）. The incidence of delirium in HFNCO group （18.18% vs. 41.67%） and ICU stay time after extubation （2.00 to 3.50） were statistically significant （all P 〈0.05）. Results There were no significant differences in the arterial blood gas analysis （PaO2,PaCO2,pH, lactate value）,PaO2, PaCO2, pH value, lactate value and LVEF at I h, 6 h, 12 h and 24 h before and after extubation in HFNCO group （all

关 键 词：经鼻高流量氧疗 急性呼吸衰竭 无创通气 治疗结果 

分 类 号：R563.8[医药卫生—呼吸系统]