急性心力衰竭有创机械通气拔管后经鼻高流量氧疗和无创机械通气的多中心前瞻性随机对照研究  

High-flow nasal cannula oxygen therapy versus non-invasive mechanical ventilation after extubation in AHF patients:a multicenter,prospective,randomized,controlled,clinical study

作　　者：刘尚香[1] 叶正龙[1] 穆心苇[2] 倪海滨[3] 张震环 左祥荣[5] 杜成[6] 李小石 王琴 张炤杰 LIU Shang-xiang;YE Zheng-long;MU Xin-wei;NI Hai-bin;ZHANG Zhen-huan;ZUO Xiang-rong;DU Cheng;LI Xiao-shi;WANG Qin;ZHANG Zhao-jie(Intensive Care Units,Nanjing Jiangbei Hospital Affiliated to Nantong University,Nanjing,Jiangsu 210048,China;不详)

机构地区：[1]南通大学附属南京江北医院ICU,江苏南京210048 [2]南京市第一医院ICU,江苏南京210006 [3]江苏省中西医结合医院ICU,江苏南京210028 [4]南京明基医院ICU,江苏南京210019 [5]江苏省人民医院ICU,江苏南京210029 [6]南京市胸科医院ICU,江苏南京210029 [7]南京市高淳人民医院ICU,江苏南京211302 [8]南京八一医院ICU,江苏南京210002 [9]南京市溧水人民医院ICU,江苏南京211299

出　　处：《中国临床研究》2022年第4期462-466,共5页Chinese Journal of Clinical Research

基　　金：南京市卫生科技发展专项资金重点项目(ZKX18053)。

摘　　要：目的比较急性心力衰竭有创机械通气拔管后经鼻高流量氧疗和无创机械通气的临床效果。方法2018年7月到2021年6月在中国南京9个ICU进行前瞻性随机对照研究,共纳入123例有创机械通气成功脱机拔管的急性心力衰竭患者,采用计算机产生的随机数字表法将患者随机分成经鼻高流量氧疗组(HFNC,n=63)和无创机械通气组(NIV,n=60),收集所有患者临床资料,评估比较二组主要观察指标、次要观察指标和不良事件的差异。结果两组患者一般临床资料、心力衰竭基本病因、合并症及超声心动图结果差异无统计学意义(P>0.05)。主要指标和次要指标:HFNC组和NIV组的再插管率(6.3%vs 6.7%)、住ICU时间[8(6,10)d vs 7(5,10)d]、总住院时间[(17.5±4.5)d vs(16.6±7.0)d]、住院死亡率(11.1%vs 10.0%),组间比较差异无统计学意义(P>0.05)。不良事件:NIV组鼻梁皮肤受损(10.0%vs 0)和胃肠胀气发生率(15.0%vs 0)明显高于HFNC组(P<0.01)。结论经鼻高流量氧疗可替代无创机械通气用于急性心力衰竭有创机械通气拔管后的序贯治疗。Objective To compare the clinical effects of high-flow nasal cannula(HFNC)oxygen therapy and non-invasive mechanical ventilation(NIV)after extubation from invasive mechanical ventilation(IMV)in the patients with acute heart failure(AHF).Methods From July 2018 to June 2021,123 AHF patients were enrolled in a prospective randomized controlled study,who were successfully weaned off the(IMV)at 9 ICUs in Nanjing.The patients were randomly divided into HFNC group(n=63)and NIV group(n=60)by use of a computer-generated table of random numbers.The clinical data for all patients were reviewed,and the main outcome measures,secondary outcome measures and adverse events were evaluated and compared between two groups.Results There was no statistical difference in general clinical data,etiology,complications and echocardiographic measures between two groups(P>0.05).There was no significant difference in re-intubation rate(6.3%vs 6.7%),length of ICU stay[8(6,10)d vs 7(5,10)d],total hospital stay[(17.5±4.5)d vs(16.6±7.0)d]and in-hospital mortality(11.1%vs 10.0%)between HFNC group and NIV group(P>0.05).The incidences of nasal bridge skin damage(10.0%vs 0)and gastrointestinal flatulence(15.0%vs 0)in NIV group were significantly higher than those in HFNC group(P<0.01).Conclusion HFNC oxygen therapy can replace NIV for sequential treatment of AHF patients after extubation from IMV.

关 键 词：急性心力衰竭 有创机械通气 经鼻高流量 无创机械通气 

分 类 号：R541.6[医药卫生—心血管疾病] R459.6[医药卫生—内科学]