加温湿化高流量鼻导管吸氧在PICU患儿撤机后的应用价值  

Application value of humidifying high-flow nasal cannula oxygen therapy after weaning of pediatric intensive care unit patients

作　　者：刘俊丽[1] 吴桂英[2] 耿晓萌 杨新利[1] 赵苗苗 史宝海[1] Liu Junli;Wu Guiying;Geng Xiaomeng;Yang Xinli;Zhao Miaomiao;Shi Baohai(Department of Children′s Medicine,Tai′an City Central Hospital(Tai′an City Central Hospital Affiliated to Qingdao University,Taishan Medical Center),Tai′an 271000,China;Department of Children′s Medicine,the First People′s Hospital of Tai′an,Tai′an 271000,China)

机构地区：[1]泰安市中心医院(青岛大学附属泰安市中心医院、泰山医养中心)儿童内科,泰安271000 [2]泰安市第一人民医院儿童内科,泰安271000

出　　处：《中国医师杂志》2022年第12期1842-1846,共5页Journal of Chinese Physician

基　　金：泰安市科技创新发展项目(2020NS238)。

摘　　要：目的探讨加温湿化高流量鼻导管吸氧(HHFNC)在儿童重症监护室(PICU)患儿撤机后的应用价值。方法前瞻性选取2018年1月至2021年10月泰安市中心医院PICU收治的42例气管插管的患儿,采用随机数字表法分为HHFNC组及经鼻持续气道正压通气(NCPAP)组,每组21例。比较两组患儿使用HHFNC及NCPAP后1 h的血气分析[PaO_(2)、PaCO_(2)、PaO_(2)/吸氧浓度(FiO_(2))]、血氧饱和度(SaO_(2))、舒适度、无创通气时间、总住院时间,记录48 h内重新气管插管率、胃食管反流、鼻损伤、面部皮肤压痕、腹胀以及肺气漏发生率。结果两组在患儿撤机后1 h的血气分析(PaO_(2),PaCO_(2),PaO_(2)/FiO_(2))、SaO_(2)、肺气漏、无创通气时间、总住院时间、48 h内重新气管插管率等方面,差异均无统计学意义(均P>0.05)。与NCPAP组比较,HHFNC组患儿舒适度更高、面部皮肤压痕、胃食管反流、鼻损伤和腹胀的发生率更低,差异有统计学意义(均P<0.05)。结论HHFNC和NCPAP均可作为撤机后过渡的呼吸支持模式,且临床治疗效果相当,HHFNC组患儿舒适度更高,更有利于提高患儿的耐受性,减少并发症,安全性更高。Objective To explore the application value of humidifying high-flow nasal cannula oxygen therapy(HHFNC)in children with pediatric intensive care unit(PICU)after weaning.Methods From January 2018 to October 2021,42 children with endotracheal intubation admitted to PICU of Tai′an city Central Hospital were prospectively selected and randomly divided into HHFNC group and nasal continuous positive airway pressure(NCPAP)group,with 21 patients in each group.The blood gas analysis[arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide in artery(PaCO_(2)),PaO_(2)/oxygen concentration(FiO_(2))],blood oxygen saturation(SaO_(2)),comfort,non-invasive ventilation time,and total hospital stay of the two groups of children 1 hour after using HHFNC and NCPAP were compared,and the rate of reintubation of trachea within 48 hours,gastroesophageal reflux,nasal injury,facial skin indentation,abdominal distension,and pulmonary air leakage were recorded.Results There was no significant difference between the two groups in terms of blood gas analysis(PaO_(2),PaCO_(2),PaO_(2)/FiO_(2)),SaO_(2),pulmonary air leakage,non-invasive ventilation time,hospital stay,and reintubation rate within 48 h after weaning(all P>0.05).Compared with NCPAP group,HHFNC group had higher comfort,lower incidence of facial skin indentation,gastroesophageal reflux,nasal injury and abdominal distension,and the difference was statistically significant(all P<0.05).Conclusions HHFNC and NCPAP can both be used as the transitional respiratory support mode after weaning,and the clinical treatment effect are similar.The HHFNC group has higher comfort,which is more conducive to improving the tolerance of children,reducing adverse reactions,and has higher safety.

关 键 词：重症监护病房 儿科 连续气道正压通气 无创通气 通气机撤除法 

分 类 号：R720.597[医药卫生—急诊医学]