ICU机械通气患者拔管后应用经鼻高流量序贯氧疗的效果分析  

Analysis of the effect of sequential high-flow nasal canula oxygen therapy in post-extubation mechanically ventilated patients in intensive care unit

作　　者：张鹏[1] 李争 江海娇[1] 周全[1] 叶小铭 袁莉萍[1] 吴郊锋 吴敬医[1] 鲁卫华[1] 陶秀彬[1] 姜小敢[1] Zhang Peng;Li Zheng;Jiang Haijiao;Zhou Quan;Ye Xiaoming;Yuan Liping;Wu Jiaofeng;Wu Jingyi;Lu Weihua;Tao Xiubin;Jiang Xiaogan(Department of Critical Care Medicine,Yijishan Hospital of Wannan Medical College,Anhui Provincial Clinical Research Center for Critical Respiratory Diseases,Wuhu 241000,Anhui,China)

机构地区：[1]皖南医学院弋矶山医院重症医学科安徽省危重症呼吸疾病临床医学研究中心,安徽芜湖241000

出　　处：《中华危重病急救医学》2021年第6期692-696,共5页Chinese Critical Care Medicine

基　　金：安徽省中央引导地方科技发展专项项目(201907d07050001);安徽省高校自然科学研究重点项目(KJ2016A718);弋矶山医院科技创新团队"攀峰"培育计划(PF2019014)。

摘　　要：目的观察重症监护病房(ICU)机械通气患者拔管后应用经鼻高流量氧疗(HFNC)的效果。方法采用前瞻性研究方法,选择2018年1月至2020年6月皖南医学院弋矶山医院收治的163例机械通气患者作为研究对象。按氧疗方式将患者分为HFNC组(82例)和传统氧疗组(81例)。入组患者均根据病情给予常规治疗,HFNC组使用经鼻高流量湿化治疗仪吸氧,气体流量根据患者耐受情况从35 L/min逐步上调至60 L/min,温度设置在34-37℃,根据患者脉搏血氧饱和度(SpO_(2))设置吸入氧浓度(FiO_(2)),维持SpO_(2)在0.95-0.98;传统氧疗组使用一次性吸氧面罩或鼻导管吸氧,氧流量5-8 L/min,维持患者SpO_(2)在0.95-0.98。比较两组患者拔管前机械通气时间、总机械通气时间、气管导管留置时间、再插管时间、撤机失败率、ICU病死率、ICU住院时间、总住院时间的差异,并分析撤机失败的原因。结果HFNC组与传统氧疗组拔管前机械通气时间(d:4.33±3.83比4.15±3.03)、气管导管留置时间(d:4.34±1.87比4.20±3.35)、ICU病死率〔4.9%(4/82)比3.7%(3/81)〕、总住院时间〔d:28.93(15.00,32.00)比27.69(15.00,38.00)〕比较差异均无统计学意义(均P>0.05)。HFNC组总机械通气时间(d:4.48±2.43比5.67±3.84)和ICU住院时间〔d:6.57(4.00,7.00)比7.74(5.00,9.00)〕均较传统氧疗组明显缩短,再插管时间较传统氧疗组明显延长(h:35.75±10.15比19.92±13.12),撤机失败率较传统氧疗组明显降低〔4.9%(4/82)比16.0%(13/81),均P<0.05〕。撤机失败的原因中,传统氧疗组气道分泌物清除障碍比例明显高于HFNC组〔8.64%(7/81)比0%(0/82),P<0.05〕,但急性心力衰竭、呼吸肌无力、低氧血症、意识改变的患者比例等比较差异均无统计学意义。结论ICU机械通气患者撤机拔管后应用HFNC序贯氧疗可降低患者拔管失败率和不良事件发生率,缩短ICU住院时间。Objective To observe the application effect of high-flow nasal canula oxygen therapy(HFNC)after extubation in patients with mechanical ventilation(MV)in the intensive care unit(ICU).Methods A prospective study was conducted.From January 2018 to June 2020,163 MV patients admitted to Yijishan Hospital of Wannan Medical College were enrolled,and they were divided into HFNC group(82 cases)and traditional oxygen therapy group(81 cases)according to the oxygen therapy model.The patients included in the study were given conventional treatment according to their condition.In the HFNC group,oxygen was inhaled by a nasal high-flow humidification therapy instrument.The gas flow was gradually increased from 35 L/min to 60 L/min according to the patient's tolerance,and the temperature was set at 34-37℃.The fraction of inspiration oxygen(FiO_(2))was set according to the patient's pulse oxygen saturation(SpO_(2))and SpO_(2) was maintained at 0.95-0.98.A disposable oxygen mask or nasal cannula was used to inhale oxygen in the traditional oxygen therapy group,and the oxygen flow was 5-8 L/min,maintaining the patient's SpO_(2) at 0.95-0.98.The differences in MV duration before extubation,total MV duration,intubation time,reintubation time,extubation failure rate,ICU mortality,ICU stay,and in-hospital stay were compared between the two groups,and weaning failure were analyzed.Results There was no significant differences in MV duration before extubation(days:4.33±3.83 vs.4.15±3.03),tracheal intubation duration(days:4.34±1.87 vs.4.20±3.35),ICU mortality[4.9%(4/82)vs.3.7%(3/81)]and in-hospital stay[days:28.93(15.00,32.00)vs.27.69(15.00,38.00)]between HFNC group and traditional oxygen therapy group(all P>0.05).The total MV duration in the HFNC group(days:4.48±2.43 vs.5.67±3.84)and ICU stay[days:6.57(4.00,7.00)vs.7.74(5.00,9.00)]were significantly shorter than those in the traditional oxygen therapy group,the reintubation duration of the HFNC group was significantly longer than that of the traditional oxygen therapy group(hours:3

关 键 词：经鼻高流量氧疗 机械通气 拔管 序贯氧疗 

分 类 号：R459.7[医药卫生—急诊医学]