高流量氧疗对老年肿瘤患者术后急性呼吸衰竭的疗效和预后影响  

Effect and prognosis of high flow nasal cannula on postoperative acute respiratory failure in elderly cancer patients

作　　者：沈永霞 胡敏[1] 张燕[1] 金广浩 SHEN Yong-xia;HU Min;ZHANG Yan;JIN Guang-hao(Nantong Tumor Hospital,Nantong 226000,Jiangsu,China)

机构地区：[1]南通市肿瘤医院,江苏南通226000

出　　处：《川北医学院学报》2022年第10期1309-1312,共4页Journal of North Sichuan Medical College

基　　金：江苏省南通市卫健委面上项目课题B(MB 2020026)。

摘　　要：目的:探讨高流量氧疗(HFNC)对老年肿瘤患者术后急性呼吸衰竭的疗效和预后的影响。方法:根据氧疗方法不同将96例老年肿瘤术后急性呼吸衰竭患者分为HFNC组(n=48)与标准氧疗组(n=48)。于氧疗前和氧疗2、12 h后,记录患者血pH值、动脉二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))和氧合指数(PaO_(2)/FiO_(2)),记录两组痰液引流量、咽痛/鼻痛发生率、舒适度评分和再插管率、48 h内肺部感染率、ICU住院时间和28 d死亡率。结果:在氧疗2、12 h后,两组PaO_(2)和PaO_(2)/FiO_(2)水平均增高(P<0.05),RR值降低(P<0.05),且相比于标准氧疗组,HFNC组PaO_(2)和PaO_(2)/FiO_(2)水平增高(P<0.05),RR值降低(P<0.05);两组PaCO_(2)相比于氧疗前均增高(P<0.05),但组间比较差异无统计学意义(P>0.05)。与标准氧疗组比较,HFNC组痰液引流量增多(P<0.05),咽痛/鼻痛发生率降低,且舒适度评分增高(P<0.05)。相比于标准氧疗组,HFNC组再插管率、48 h肺部感染率均降低(P<0.05),ICU住院时间缩短(P<0.05);两组28 d病死率比较,差异无统计学意义(P>0.05)。结论:HFNC应用于老年肿瘤患者术后急性呼吸衰竭中,相比于标准氧疗,有着较好的氧疗疗效,降低再插管率,提高舒适度,促进患者康复。Objective:To investigate the effect and prognosis of high-flow nasal cannula(HFNC)on postoperative acute respiratory failure in elderly cancer patients.Methods:A total of 96 elderly patients with acute respiratory failure after tumor surgery were divided into HFNC group(n=48)and standard oxygen therapy group(n=48)according to different oxygen therapy methods.Before and 2 h and 12 h after oxygen therapy,pH,arterial carbon dioxide partial pressure(PaCO_(2)),blood oxygen partial pressure(PaO_(2))and oxygenation index(PaO_(2)/FiO_(2))were recorded,and sputum drainage,incidence of sore throat/nasal pain,comfort score and reintubation rate,pulmonary infection rate within 48 h,ICU hospitalization time and 28 d mortality rate were recorded.Results:After 2 h and 12 h of oxygen therapy,PaO_(2)and PaO_(2)/FiO_(2)levels in both groups were increased(P<0.05),RR was decreased(P<0.05).Compared with the standard oxygen therapy group,the levels of PaO_(2)and PaO_(2)/FiO_(2)in the HFNC group were increased(P<0.05),and the RR value was decreased(P<0.05).PaCO_(2)in both groups was higher than that before oxygen therapy(P<0.05),but there was no significant difference between the two groups(P>0.05).Compared with the standard oxygen therapy group,the sputum drainage volume in the HFNC group was increased(P<0.05),the incidence of sore throat/nasal pain was decreased,and the comfort score was increased(P<0.05).Compared with the standard oxygen therapy group,the re-intubation rate and 48 h pulmonary infection rate in the HFNC group were decreased(P<0.05),and the ICU hospitalization time was shortened(P<0.05).There was no significant difference in 28 d mortality between the two groups(P>0.05).Conclusion:HFNC is applied to elderly patients with acute respiratory failure after tumor surgery.Compared with standard oxygen therapy,it has better curative effect of oxygen therapy,reduces the re-intubation rate,improves comfort and promotes the rehabilitation of patients.

关 键 词：急性呼吸衰竭 肿瘤 高流量氧疗 标准氧疗 老年 呼吸参数 气管插管 预后 

分 类 号：R563.8[医药卫生—呼吸系统] R730.6[医药卫生—内科学]