持续无创通气预防急性呼吸窘迫综合征患者气管插管时的低氧血症  

Continuous noninvasive ventilation prevent hypoxemia during intubation in ARDS patients

作　　者：农凌波[1] 杨淳[1] 张容[1] 梁微波[1] 余裕恒 陈荣昌[1] NONG Lingbo;YANG Chun;ZHANG Rong;LIANG Weibo;YU Yuheng;CHEN Rongchang(Department of Critical Care Medicine,Guangzhou Institute of Respiratory Health,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院,广州呼吸健康研究院,广州510120

出　　处：《实用医学杂志》2020年第16期2261-2263,2268,共4页The Journal of Practical Medicine

基　　金：广东省科技创新战略专项(编号:2018KJYZ020);2017年国家自然科学基金青年基金项目(编号:81700080)。

摘　　要：目的评估无创通气(NIV)在急性呼吸窘迫综合征(ARDS)患者气管插管中预防低氧血症的应用价值。方法研究纳入2015年6月至2017年6月在广州医科大学附属第一医院ICU气管插管的ARDS患者。比较纤支镜经鼻气管插管(对照组)和NIV辅助纤支镜经鼻气管插管(NIV组)的差异,探讨NIV在ARDS气管插管中的应用价值。结果对照组17例、NIV组16例ARDS患者被纳入亚组分析。对照组和NIV组的基础SpO2相似[(87.7±9.1)%vs.(87.8±8.7)%,P=0.973]。预氧合后NIV组的SpO2高于对照组[(96.8±4.0)%vs.(90.4±9.2)%,P=0.015]。气管插管时,NIV组最低SpO2显著高于对照组[(90.3±9.0)%vs.(74.4±12.9)%,P<0.001]。结论与常规的纤支镜经鼻气管插管相比,持续NIV能够有效预防ARDS患者气管插管时的低氧血症。Objective To investigate the application value of noninvasive ventilation(NIV)in the prevention of hypoxemia during intubation in patients with acute respiratory distress syndrome(ARDS).Methods The ARDS patients who were intubated in the IC.U of the First Affiliated Hospital of Guangzhou Medical University from June 2015 to June 2017 were included.The data of the control group(traditional fiberoptic bronchoscopy(FOB)nasotracheal intubation)and the NIV group(NIV-assisted FOB nasotracheal intubation)were compared and the application values of NIV during intubation of ARDS patients were evaluated.Results 17 ARDS patients in the Control group and 16 ARDS patients in the NIV group were included in the subgroup analysis.Baseline SpO2 of the two groups was similar[(87.7±9.1)%vs.(87.8±8.7)%,P=0.973].After preoxygenation,the SpO2 in the NIV group was higher than the control group[(96.8±4.0)%vs.(90.4±9.2)%,P=0.015].During intubation,the lowest SpO2 in the NIV group was higher than the control group[(90.3±9.0)%vs.(74.4±12.9)%,P<0.001].Conclusion NIV is effective to prevent hypoxemia during FOB nasotracheal intubation in ARDS patients compared with the traditional method.

关 键 词：无创通气 急性呼吸窘迫综合征 气管插管 纤维支气管镜 低氧血症 

分 类 号：R459.7[医药卫生—急诊医学]