高流量氧疗与无创正压通气对全麻胃肠手术后急性呼吸衰竭患者氧疗效果及预后影响的前瞻性随机对照研究  

Effect of high-flow nasal cannula oxygen therapy and non-invasive ventilation on patients with acute respiratory failure after gastrointestinal operation under general anesthesia:a prospective randomized controlled trial

作　　者：顾彩虹[1] 刘素霞[1] 刘克喜[1] 谢永鹏[1] 陈晓兵[1] 徐采云[1] 康秀文[1] 王婉 Gu Caihong;Liu Shuxia;Liu Kexi;Xie Yongpeng;Chen Xiaobin;Xu Caiyun;Wang Wan(Department of Intensive Care Unit,the First People's Hospital of Lianyungang,Lianyungang 222000,China)

机构地区：[1]连云港市第一人民医院重症医学科,222000

出　　处：《中华急诊医学杂志》2020年第2期262-267,共6页Chinese Journal of Emergency Medicine

基　　金：连云港市科技局社会发展基金(SH1601)。

摘　　要：目的观察高流量氧疗(HFNC)对全麻胃肠手术后急性呼吸衰竭患者的氧疗效果及对预后的影响。方法选取2017.01至2019.06入住本院ICU全麻胃肠手术后急性呼吸衰竭患者107例,随机(随机数字法)分为HFNC组57例和无创正压通气(NIV)组50例,比较两组患者氧疗前、氧疗后2h、6h、12h的pH、PaO2、PaCO2,SaO2,氧合指数(PaO2/FiO2)心率(HR)、呼吸频率(RR)、腹内压(IAP)的变化,比较两组患者在氧疗过程中患者舒适度、氧疗时间、再次插管率、48h肺部感染率、吻合口痿发生率、ICU住院时间、总住院时间、住院花费,28 d病死率的差别。正态计量资料比较采用两独立样本r检验。非正态数据采用中位数(四分位数)表示,分计数资料采用例数(百分比)表示,两组间比较采用护检验。结果两组患者在氧疗0、2h PaO2、PaCO2、PaO2/FiO2、SpO2差异无统计学意义;氧疗后6h HFNC组pH低于对照组(7.39±0.04 vs.7.42±0.03),PaO2、PaCO2、PaO2/FiO2,SpO2高于NIV组[(89.22±8.70 vs.84.99±9.76)mmHg,(41.3±3.43 vs.39.34±4.21)mmHg,(250.07±18.34 vs.237.89±19.38)mmHg,(96.14±2.19 vs.94.78±2.76)%],差异有统计学意义,(P<0.05);氧疗后12 h,HFNC组pH、PaO2、PaCO2、PaO2/FiO2、SpO2高于NIV组[(7.39±0.04 vs.7.36±0.04),(97.2±12.45 vs.93.82±12.54)mmHg,(40.84±5.22 vs.45.10±6.40)mmHg,(277.16±13.98 vs.248.86±12.81)mmHg,(98.14±1.64 vs.95.48±2.71)%],差异有统计学意义。HFNC组在氧疗2、6、12h HR、RR、IAP均低于NIV组,差异有统计学意义。HFNC组氧疗时间少于NIV组(32.01±7.57 vs.40.88±8.89)h,再插管率低于NIV组(1.75 vs.12)%,氧疗后48 h内肺部感染率低于NIV组(8.78 vs.30)%,ICU住院时间少于NIV组,(5.61±1.73 vs.7.60±2.31)d,住院花费低于NIV组,差异有统计学意义(t=4.822,P<0.05);结论HFNC能显著提高全麻胃肠手术后急性低氧血症患者的PaO2、PaO2/FiO2、SpO2,减少氧疗时间,降低再插管率,降低48 h内肺部感染率,对腹内压无影响,改善预后。objective To observe the effect of high-flow nasal cannula(HFNC)oxygen therapy on patients with acute respiratory failure after gastrointestinal operation under general anesthesia and its efficacy on prognosis.Methods Totally 107 patients with acute respiratory failure after gastrointestinal operation under general anesthesia in ICU of our hospital were selected from January 2017 to June 2019.Patients were randomly divided into the HFNC group(n=57)and non-invasive ventilation(NIV)group(n=50).The changes of pH,PaO2,PaCO2,PaO2/FiO2,SpO2,heart rate(HR),respiration rate(RR),and intra-abdominal pressure(IAP)before and after oxygen treatment were compared.The differences of comfort level,duration of oxygen treatment,re-intubation rate,48-h pulmonary infection rate,incidence of anastomotic fistula,length of stay in ICU,length of hospital stay,hospitalization cost,and 28-day mortality were compared between the two groups.The t test of two independent samples was used for the comparison of normal measurement data.Non-normal data were expressed by median(quartile),fractional count data by case number(percentage),and comparison between the two groups by Chi-square test.Results PaO2,PaCO2,PaO2/FiO2 and SpO2 were not significantly different after 2-h oxygen therapy.PH of the HFNC group was lower than that of the NIV group(7.39±0.04 vs.7.42±0.03),PaO2,PaCO2,PaO2/FiO2 and SpO2 were higher than that of the NIV group[(89.22±8.70)vs.(84.99±9.76)mmHg,(41.3±3.43)vs.(39.34±4.21)mmHg,(250.07±18.34)vs.(237.89±19.38)mmHg,(96.14±2.19)vs.(94.78±2.76)%>P<0.05];pH,PaO2,PaCO2,PaO2/FiO2 and SpO2 were significantly higher in the HFNC group than those in the NIV group[(7.39±0.04)vs.(7.36±0.04);(97.2±12.45)vs.(93.82±12.54)mmHg;(40.84土5.22)vs.(45.10±6.40)mmHg;(277.16±13.98)vs.(248.86±12.81)mmHg,(98.14±1.64)%vs.(95.48±2.71)%]after 12 h oxygen treatment.The HR,RR and IAP of the HFNC group were lower than those of the NIV group,and the differences were statistically significant(P v 0.05).The duration of oxygen therapy in the HFN

关 键 词：经鼻高流量氧疗 无创正压通气 全身麻醉 胃肠手术 急性呼吸衰竭 

分 类 号：R563.8[医药卫生—呼吸系统] R656[医药卫生—内科学]