序贯高流量气管内吸氧在脑卒中后气管切开患者脱机过程中的应用价值  

The application value of sequential high flow endotracheal oxygen inhalation on the patients with stroke in the weaning from mechanical ventilation process after tracheotomy

作　　者：陆件[1] 倪兴梅 沈奕[1] Lu Jian;Ni Xing-mei;Shen Yi(Dapartment of Emergency and Intensive Care Unit,Suzhou Hospital Affiliated to Nanjing Medical University,Suzhou 215002,China)

机构地区：[1]南京医科大学附属苏州医院急诊重症医学科,江苏苏州215002

出　　处：《中国急救医学》2019年第10期963-966,共4页Chinese Journal of Critical Care Medicine

摘　　要：目的评估高流量气管内吸氧(HFETOI)在气管切开患者脱机过程中序贯治疗的可行性及临床疗效.方法采用回顾性队列研究方法,选择2015年1月至2019年4月南京医科大学附属苏州医院急诊与重症医学科气管切开接受有创机械通气治疗,需要脱机锻炼的脑卒中患者45例,按脱机过程中给氧方式不同分为高流量气管内吸氧(HFETOI)组22例和气切面罩吸氧(TMOI)组23例.分别于研究开始第0、6、12、24、48 h记录两组患者的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)及痰液黏稠度,并进行床旁动脉血气分析,计算1周内患者需要再次机械通气支持的时间总和,分析HFETOI或TMOI对气管切开患者脱机后氧合的改善作用.结果HFETOI组和TMOI组序贯治疗12 h HR(次/min)(82.4±18.4 vs.90.4±16.7)、24 h HR(79.8±16.8 vs.88.4±14.6)、48 h HR(78.4±17.1 vs.87.4±12.4)后差异具有统计学意义(P<0.05);24 h RR(次/min)(17.2±4.1 vs.22.4±5.4)、48 h RR(15.6±3.9 vs.21.6±5.2)后两组差异具有统计学意义(P<0.05),两组MAP差异无统计学意义(P>0.05).HFETOI组序贯治疗12 h(89.6±15.6 vs.79.9±16.7)、24 h(93.8±21.5 vs.80.2±19.6)、48 h(94.2±18.1 vs.84.6±18.4)后的动脉血氧分压(PaO2,mm Hg)与TMOI组比较差异具有统计学意义(P<0.05).HFETOI组在序贯治疗48 h后,患者气道内痰液黏稠度与TMOI组比较,差异具有统计学意义(P<0.05).HFETOI组在序贯治疗一周内需要再次机械通气支持的时间总和(h:12.2±8.3 vs.21.4±11.5)与TMOI组比较,差异有统计学意义(P<0.05).结论气管切开后患者在试脱机过程中序贯HFETOI,可以维持较高的氧分压,减少缺氧带来的HR和RR的增加,并能够有效稀释痰液,从而减少机械通气支持力度,以达到完全脱机的目的.Objective To evaluate the feasibility and clinical efficacy of sequential treatment of high flow endotracheal oxygen inhalation(HFETOI)in patients with stroke after tracheotomy in the course of weaning ventilation.Methods The 45 patients who were hospitalized due to stroke and tried weaning from invasive mechanical ventilation after tracheostomy from Jan 2015 to Dec 2018 in emergeney and intensive care unit department of Suzhou Hospital Affiliated to Naning Medical University were divided into HFETOI(22 cases)or tracheotomy mask oxygen inhalation(TMOI)(23 cases)group by the method of cohort study.Heart rate,respiratory frequency,blood pressure and sputum viscosity of the patients were recorded at 0.6.12.24 and 48 hours after sequential treatment,and para-bed arterial blood gas analysis were performed.The total time of mechanical ventilation support again within 1 weel was calculated,and the improvement effect of HFETOI or TMOI on the oxvgenation after tracheotomy was analyzed.Results There were statistically significant differences in heart rate(HR)of the HFETOI group comparing to TMOI group after 12 h(82.4±18.4 vs.90.4±16.7),24 h(79.8±16.8 vs.88.4±14.6)and 48 h(78.4±17.1 vs.87.4±12.4)of sequential treatment(P<0.05),the respiratory rate(RR)of HFETOI group was statistically different comparing to TMOI after 24 h(17.2±4.1 vs.22.4±5.4)and 48 h(15.6±3.9 vs.21.6±5.2)of sequential treatment(P<0.05),and no statistically significant differences in mean arterial pressure(MAP)between the two groups(P>0.05).The arterial partial pressure of oxygen(PaO2)after 12 h(89.6±15.6vs.79.9±16.7),24 h(93.8±21.5 vs.80.2±19.6)and 48 h(94.2±18.1 vs.84.6±18.4)of sequential treatment in HFETOI group was statistically significant compared with that in TMOI group(P<0.05).The cases of sputum viscosity attenuating 48 h after sequential treatment in HFETOI group were statistically different to TMOI group(P<0.05).Compared with TMOI group,HFETOI group reduced the total time(12.2±8.3 vs.21.4±11.5)required for re-mechanical ventila

关 键 词：高流量吸氧 脑卒中 气管切开 脱机 

分 类 号：R47[医药卫生—护理学]