高流量湿化氧疗与无创正压通气在机械通气撤离序贯治疗中疗效对比研究  

A comparative study on the effect of high flow humidification oxygen therapy and noninvasive positive pressure ventilation in sequential treatment of mechanical ventilation evacuation

作　　者：曲忠慧 巴春贺[1] 王国玉[1] 辛秋平 李子寅 QU Zhong-hui;BA Chun-he;WANG Guo-yu;XIN Qiu-ping;LI Zi-yin(Department of Geriatrics,Affiliated Hospital of Chengde Medical College,Chengde 067000,China)

机构地区：[1]承德医学院附属医院老年病科,河北承德067000

出　　处：《创伤与急危重病医学》2020年第5期338-341,共4页Trauma and Critical Care Medicine

基　　金：承德市科学技术局基金项目(201606A037)。

摘　　要：目的探讨高流量湿化氧疗与无创正压通气在机械通气撤离序贯治疗中的疗效。方法选取自2016年3月至2019年3月承德医学院附属医院老年病科收治的行气管插管机械通气患者48例,在机械通气撤离序贯治疗中,应用无创正压通气的患者为A组(n=24),应用高流量湿化氧疗的患者为B组(n=24)。比较两组患者机械通气撤离24 h后痰液湿化效果、相关临床指标、不良事件及并发症发生情况。结果机械通气撤离24 h后,B组湿化不足患者比例低于A组,湿化满意患者比例高于A组,差异有统计学意义(P<0.05)。机械通气撤离1 h、24 h,两组患者动脉血氧分压、二氧化碳分压比较,差异均无统计学意义(P>0.05)。B组患者舒适度评分、焦虑评分、总通气治疗时间、住院时间均低于A组,且呼吸机相关性肺炎发生率低于A组,差异均有统计学意义(P<0.05)。两组患者28 d内再插管率比较,差异无统计学意义(P>0.05)。B组患者压疮、误吸发生率及28 d内病死率均低于A组,差异有统计学意义(P<0.05)。结论在机械通气撤离序贯治疗中应用高流量湿化氧疗,可维持患者气道湿润度始终处于类似生理湿化状况,利于患者分泌物排出,确保高氧疗效果。Objective To investigate the efficacy of high flow humidified oxygen therapy and non-invasive positive pressure ventilation in the sequential treatment of mechanical ventilation evacuation.Methods A retrospective study was performed on 48 cases of patients underwent endotracheal intubation and mechanical ventilation who were admitted from March 2016 to March 2019.In the sequential treatment of mechanical ventilation evacuation,patients receiving non-invasive positive pressure ventilation were in Group A(n=24)and patients receiving high-flow humidified oxygen therapy were in Group B(n=24).The results of sputum humidification,relevant clinical indicators,adverse events and complications were compared between the two groups 24 hours after mechanical ventilation withdrawal.Results Twhenty-four hours after mechanical ventilation withdrawal,the proportion of patients with insufficient humidification in Group B was lower than that in Group A,and the proportion of patients with satisfactory humidification was higher than that in Group A,with statistically significant differences(P<0.05).One and twenty-four hours after mechanical ventilation,arterial partial pressure of oxygen and partial pressure of carbon dioxide showed no statistically significant difference between the two groups(P>0.05).The comfort score,anxiety score,total ventilation treatment time and hospital stay time of patients in Group B were all lower than those in Group A,and the incidence of ventilator-associated pneumonia was lower than that in Group A(P<0.05).There was no significant difference in the rate of re-intubation within 28 days between the two groups(P>0.05).The incidence of pressure ulcers,aspiration and mortality within 28 days in Group B were all lower than those in Group A(P<0.05).Conclusion The application of flow humidification oxygen therapy in the sequential treatment of mechanical ventilation evacuation can maintain the moist degree of patients′airway in the similar physiological humidification condition,which is conducive to dischar

关 键 词：高流量湿化氧疗 无创正压通气 机械通气撤离 序贯治疗 

分 类 号：R459.7[医药卫生—急诊医学]