用两种通气疗法对气管插管拔管后存在呼吸衰竭风险的患者进行治疗的效果对比  

Comparison of outcomes of two ventilation therapies in patients at risk o f respiratory failure following tracheal intubation and extubation

作　　者：夏小琴 王倩[1] 关云艳[1] 吴锡平[1] 王亮[1] 孙月雯[1] 沈丽娟[1] XIA Xiaoqin;WANG Qian;GUAN Yunyan;WU Xiping;WANG Liang;Sun Yuewen;SHEN Lijuan(Department of Critical Care,Wuxi Hospital of Traditional Chinese Medici ne,Wuxi Jiangsu 214071)

机构地区：[1]无锡市中医医院重症医学科,江苏无锡214071

出　　处：《当代医药论丛》2021年第6期3-5,共3页

摘　　要：目的:分析并比较对气管插管拔管后存在呼吸衰竭风险的患者进行经鼻高流量湿化氧疗与无创正压通气的效果。方法:选择2017年1月至2019年9月期间在无锡市中医医院重症监护室(ICU)进行气管插管机械通气且在拔管后存在呼吸衰竭风险的51例患者作为研究对象。随机将其分为观察组(n=24)与对照组(n=27)。在拔管后,分别对观察组患者与对照组患者进行经鼻高流量湿化氧疗与无创正压通气,然后比较两组患者的各项临床指标。结果:两组患者拔管后48 h内再插管的发生率、拔管后7 d内再插管的发生率、拔管后入住ICU的时间及拔管后28 d内的死亡率相比,差异无统计学意义(P>0.05)。两组患者拔管后24 h的心率、呼吸频率、血液pH、PCO2及氧合指数相比,差异无统计学意义(P>0.05)。两组患者拔管后48 h的心率、呼吸频率、血液pH、PO2、PCO2及氧合指数相比,差异无统计学意义(P>0.05)。观察组患者拔管后镇静剂的使用率低于对照组患者,差异有统计学意义(P<0.05)。结论:对气管插管拔管后存在呼吸衰竭风险的患者进行经鼻高流量湿化氧疗与无创正压通气的效果相当,但对其进行经鼻高流量湿化氧疗能提高其对通气治疗的耐受性,降低其镇静药物的使用率。Objective:To analyze and compare the effects of intranasal high-flow humidification oxygen therapy and non-invasive positive pressure ventilation in patients at risk of respiratory failure after endotracheal intubation and extubation.METHODS:Fifty-one patients with endotracheal intubation and mechanical ventilation at risk of respiratory failure after extubation were enrolled in the study from January 2017 to September 2019 in the ICU of Wuxi Hospital of Traditional Chinese Medicine.They were randomly divided into observation group(n=24)and control group(n=27).After extubation,patients in the observation group and the control group were treated with nasal high-flow humidification oxygen therapy and non-invasive positive pressure ventilation respectively,and then the clinical indicators of the two groups were compared.RESULTS:There were no significant differences in the incidence of reintubation within 48 h after extubation,the incidence of reintubation within 7 d after extubation,the time of stay in ICU after extubation and the mortality within 28 d after extubation between 2 groups(P>0.05).There were no significant differences in heart rate,respiratory rate,blood pH,PCO2 and oxygenation index between 2 groups at 24 h after extubation(P>0.05).There was no statistical significance in heart rate,respiratory rate,blood pH,PO2,PCO2 and oxygenation index between 2 groups 48 h after extubation(P>0.05).The utilization rate of sedatives in observation group was lower than control group after extubation,the difference was statistically significant(P<0.05).CONCLUSIONS:The effect of intranasal high-flow humidifying oxygen therapy for patients at risk of respiratory failure after endotracheal intubation and extubation is equivalent to that of non-invasive positive pressure ventilation,but intranasal high-flow humidifying oxygen therapy can improve their tolerance to ventilation treatment and reduce the use rate o f sedatives.

关 键 词：气管插管 机械通气 拔管 呼吸衰竭 经鼻高流量湿化氧疗 无创正压通气 

分 类 号：R459.6[医药卫生—治疗学]