高流量湿化氧对危重患者脱机后呼吸功能的保护作用  

Protective effects of humidified and heated high flow oxygen therapy for critically ill patients after extubation

作　　者：陈元杰[1] 孙莉 彭琳[1] 丁宁[1] 费苗苗 严姝姝 万小健[1] 朱科明[1] CHEN Yuanjie;SUN Li;PENG Ling;DING Ning;FEI Miaomiao;YAN Susu;WAN Xiaojian;ZHU Keming(Critical Care Medicine Department of Anesthesiology Institution of Changhai Hospital, the Second Military Medicine University, Shanghai 200433, P. R. Chin)

机构地区：[1]第二军医大学附属长海医院麻醉学部重症医学科,上海200433

出　　处：《中国呼吸与危重监护杂志》2018年第3期259-262,共4页Chinese Journal of Respiratory and Critical Care Medicine

摘　　要：目的研究高流量湿化氧治疗对重症监护病房(ICU)危重患者脱离呼吸机后的呼吸功能保护作用。方法将2014年1月至2016年12月期间收入我院重症医学科需呼吸机支持48 h以上的患者随机分为两组,患者在脱离呼吸机后分别给予高流量湿化氧治疗(HFM组)和常规鼻导管或面罩吸氧(TO组)治疗。其中,HFM组共236例,男116例,女120例,平均年龄(55.3±21.1)岁;TO组共251例,男129例,女122例,平均年龄(58.4±19.3)岁。监测患者动脉血气分析,记录动脉血氧分压、动脉血二氧化碳分压(Pa CO2)、吸入氧浓度、呼吸频率、自主呼吸时间,计算氧合指数、再次插管机械通气率、ICU停留时间以及住院时间。结果两组患者氧合指数在拔管前比较,差异无统计学意义(P>0.05),而HFM组拔管后2、4、8、24、48 h氧合指数均明显高于TO组(P<0.05),PaCO_2及呼吸频率方面两组间比较,差异无统计学意义(P>0.05)。HFM组需要再次插管机械通气明显低于TO组(4.2%比10.4%,P<0.05),自主呼吸天数明显高于TO组[(5.4±3.2)d比(3.5±2.5)d,P<0.05]。尽管两组患者在总住院天数上比较,差异无统计学意义[(26.5±6.5)d比(27.8±5.8)d,P>0.05],而HFM组ICU滞留天数明显低于TO组[(10.5±6.1)d比(14.3±8.5)d,P<0.05]。结论使用高流量湿化氧治疗可以降低ICU危重患者脱机拔管后再次插管率,改善氧合功能,对呼吸功能有一定的保护作用。Objectives To explore the efficacy of humidified and heated high flow oxygen therapy for the critically ill patients in intensive care unit（ICU） after extubation. Methods From January 2014 to December 2016, 487 patients were enrolled. Patients were allocated to two treatment groups randomly, which were humidified and heated high flow oxygen therapy group（236 patients, HFM group, aged 55.3±21.1 years old） and routine oxygen therapy group（251 patients, TO group, aged 58.4±19.3 years old）. Blood oxygen saturation, arterial partial pressure of oxygen（PaO2）, arterial partial pressure of carbon dioxide（PaCO2）, fraction of inspired oxygen（FiO2）, respiratory frequency, incidence rate of reintubation, ventilator-free days, ICU length of stay, and hospital stay were assessed and compared between the HFM group and the TO group. Results The hospital stay was similar in two groups. There were more ventilator-free days in the HFM group（P〈0.05）, fewer patients required reintubation（4.2% vs. 10.4%, P〈0.05） and less ICU length of stay[（10.5±6.1） d vs.（14.3±8.5） d, P〈0.05]. PaO2/FiO2 of the HFM group were better than the TO group after extubation at 2 h,4 h, 8 h, 24 h, and 48 h（P〈0.05）. There were no statistically significant differences in respiratory frequency and PaCO2.Conclusions Humidified and heated high flow oxygen therapy can supply a better oxygenation for patients after extubation in ICU. It could be a common therapy in ICU for the critically patients after extubation.

关 键 词：高流量湿化氧 危重患者 呼吸功能保护 

分 类 号：R459.7[医药卫生—急诊医学]