高流量湿化吸氧对心脏外科手术患者低氧血症治疗效果及术后撤机时间的影响  

The effect of high flow humidification oxygen inhalation on hypoxemia in patients undergoing cardiac surgery and the effect of postoperative weaning time

作　　者：陈蓉蓉 严明琦 康磊[1] Chen Rongrong;Yan Mingqi;Kang Lei(Department of Cardiology,Ruijin Hospital,Medical College,Shanghai Jiaotong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属瑞金医院心脏外科,200025

出　　处：《中国实用护理杂志》2021年第22期1722-1727,共6页Chinese Journal of Practical Nursing

摘　　要：目的探讨高流量湿化吸氧对心脏外科手术患者低氧血症的治疗效果及术后撤机时间的影响,为临床治疗提供参考依据。方法选择2018年1月至2020年1月接受心脏外科手术后出现低氧血症的80例患者为研究对象,按照随机数字表法分为观察组和对照组各40例。对照组给予无创正压通气治疗,观察组给予高流量湿化吸氧治疗。比较2组撤机时间及治疗前后2、6、24 h的动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)、pH值、自主呼吸频率(RR)、心率以及并发症发生率。结果观察组撤机时间为(35.51±4.61)h,对照组为(44.04±3.85)h,差异有统计学意义(t值为8.982,P<0.01);观察组治疗后2、6、24 h PaO2分别为(73.96±4.32)、(79.82±3.61)、(94.82±2.71)mmHg(1 mmHg=0.133 kPa),对照组分别为(70.72±3.10)、(75.63±3.88)、(90.27±3.55)mmHg,2组比较差异有统计学意义(t值为3.854、5.000、6.443,均P<0.01);观察组治疗后2、6、24 h PaO2/FiO2分别为(239.45±18.74)、(269.85±20.09)、(291.83±17.30)mmHg,对照组分别为(226.74±20.72)、(251.12±16.74)、(279.65±19.40)mmHg,2组比较差异有统计学意义(t值为2.877、4.530、2.964,均P<0.01);观察组治疗后2、6、24 h呼吸分别为(24.74±2.03)、(22.61±1.86)、(18.63±2.05)次/min,对照组分别为(26.07±1.89)、(24.24±1.73)、(20.11±1.87)次/min,2组比较差异有统计学意义(t值为3.033、4.058、3.373,均P<0.01);观察组治疗后2、6、24 h心率分别为(83.32±4.88)、(76.06±4.71)、(70.34±3.82)次/min,对照组分别为(86.06±3.29)、(80.91±4.31)、(75.71±6.22)次/min,2组比较差异有统计学意义(t值为2.944、4.805、4.653,均P<0.01);观察组并发症总发生率为7.50%(3/40),对照组为25.00%(10/40),2组比较差异有统计学意义(χ2值为4.501,P<0.05)。结论高流量湿化吸氧治疗心脏外科手术后低氧血症患者疗效显著,可有效改善血气指标,缩短撤机时间,并减少并发症发生率,安全性好,值得应用推�Objective To study the effect of high flow humidification oxygen inhalation on hypoxemia in patients undergoing cardiac surgery and the effect of postoperative weaning time.Methods A total of 80 patients with hypoxemia after cardiac surgery from January 2018 to January 2020 were selected for the study,according to the random number table,they were divided into the observation group and the control group,40 cases each.The control group was treated with noninvasive positive pressure ventilation,while the observation group was treated with high flow humidification and oxygen absorption.The weaning time,the changes of the arterial oxygen partial pressure(PaO2),partial pressure of carbon dioxide(PaCO2),oxygenation index(PaO2/FiO2),pH value,spontaneous breathing frequency(RR),heart rate before and after treatment 2 h,6 h,24 h,and the incidence of complications were compared between the two groups.Results The weaning time in the observation group was(35.51±4.61)h,and that in the control group was(44.04±3.85)h,the difference was statistically significant(t value was 8.982,P<0.01).The PaO2 in the observation group at 2,6,24 h after treatment were(73.96±4.32),(79.82±3.61),(94.82±2.71)mmHg(1 mmHg=0.133 kPa),and those in the control group were(70.72±3.10),(75.63±3.88),(90.27±3.55)mmHg,the differences were statistically significant(t values were 3.854,5.000,6.443,P<0.01).The PaO2/FiO2 in the observation group at 2,6,24 h after treatment were(239.45±18.74),(269.85±20.09),(291.83±17.30)mmHg,and those in the control group were(226.74±20.72),(251.12±16.74),(279.65±19.40)mmHg,the differences were statistically significant(t values were 2.877,4.530,2.964,P<0.01).The RR in the observation group at 2,6,24 h after treatment were(24.74±2.03),(22.61±1.86),(18.63±2.05)times/min,and those in the control group were(26.07±1.89),(24.24±1.73),(20.11±1.87)times/min,the differences were statistically significant(t values were 3.033,4.058,3.373,P<0.01).The heart rate in the observation group at 2,6,24 h after treatment were(8

关 键 词：低氧血症 心脏外科手术 高流量湿化吸氧 无创正压通气 撤机时间 并发症 

分 类 号：R473.6[医药卫生—护理学]