经鼻高流量氧疗与无创机械通气在急性呼吸衰竭患者拔管后序贯治疗中的应用效果比较  

Comparison of effect of nasal high-flow oxygen therapy and non-invasive mechanical ventilation in the sequential treatment of acute respiratory failure after extubation

作　　者：李敏[1] 张霞[1] Li Min;Zhang Xia(Intensive Care Unit Center,Henan Provincial People’s Hospital,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院中心ICU,郑州450003

出　　处：《中国实用医刊》2023年第2期40-43,共4页Chinese Journal of Practical Medicine

摘　　要：目的分析急性呼吸衰竭(ARF)患者拔管后序贯治疗中采用经鼻高流量氧疗(HFNC)和无创机械通气(NIV)的效果。方法抽取河南省人民医院2017年1月至2021年12月收治的行机械通气治疗的ARF患者74例,按双色球法分为对照组和观察组,每组37例。对照组患者在拔管后采取NIV序贯治疗,观察组患者在拔管后采取HFNC序贯治疗。比较两组氧合指数、序贯性器官功能衰竭评价系统(SOFA)评分、急性生理与慢性健康Ⅱ评分(APACHEⅡ评分)、血气分析指标(动脉血氧分压、二氧化碳分压)、住院时间及随访3个月时的再插管率、再住院死亡率。结果治疗前,两组氧合指数、SOFA评分、APACHEⅡ评分、血气分析指标比较差异未见统计学意义(P>0.05)。治疗后,观察组SOFA评分[(4.73±2.05)分]、APACHEⅡ评分[(12.14±2.45)分]、二氧化碳分压[(52.13±5.09)mmHg,1 mmHg=0.133 kPa]均低于对照组[(5.92±2.17)分、(15.22±2.21)分、(56.32±4.42)mmHg],氧合指数[(322.84±48.27)mmHg]、动脉血氧分压[(78.23±9.47)mmHg]高于对照组[(288.69±61.11)、(61.34±7.88)mmHg],P<0.05。观察组住院时间[(24.43±8.74)d]短于对照组[(30.3±11.22)d],P<0.05;随访3个月,观察组再插管率(13.51%,5/37)低于对照组(35.14%,13/37),P<0.05,但两组再住院病死率比较差异未见统计学意义(P>0.05)。结论ARF患者拔管后序贯治疗中采取HFNC方案,与NIV方案比较,可更好地改善患者的血气分析指标、氧合指数,减轻器官衰竭状况,提高健康水平,缩短住院时间,降低再插管率。Objective To analyze the effects of high-flow nasal oxygen therapy(HFNC)and non-invasive mechanical ventilation(NIV)in the sequential treatment of acute respiratory failure(ARF)after extubation.Methods Seventy-four patients with ARF receiving mechanical ventilation in Henan Provincial People’s Hospital from January 2017 to December 2021 were selected.And they were divided into control group and observation group according to the double chromosphere method,with 37 cases in each group.The patients in the control group received NIV sequential therapy after extubation,while the observation group received HFNC sequential therapy after extubation.The oxygenation index,sepsis-related organ failure assessment(SOFA)score,acute physiology and chronic health evaluationⅡ(APACHE II)score,and blood gas analysis indicators(arterial blood oxygen partial pressure,carbon dioxide partial pressure),the duration of hospital stay,the rate of re-intubation and case fatality rate during re-hospitallization in 3-month follow-up of the two groups were compared.Results Before treatment,there was no significant difference in oxygenation index,SOFA score,APACHE II score,blood gas analysis indicators between the two groups(P>0.05).After treatment,SOFA score,APACHEⅡscore,partial pressure of carbon dioxide in the observation group were 4.73±2.05,12.14±2.45,and(52.13±5.09)mmHg(1 mmHg=0.133 kPa),which were lower than the 5.92±2.17,15.22±2.21,(56.32±4.42)mmHg in the control group correspondingly(P<0.05),while oxygenation index and partial pressure of arterial oxygen in the observation group were(322.84±48.27)mmHg and(78.23±9.47)mmHg,which were higher than the(288.69±61.11)mmHg and(61.34±7.88)mmHg in the control group(P<0.05).The duration of hospital stay in the observation group was(24.43±8.74)d,shorter than the(30.3±11.22)d in the control group(P<0.05).After 3 months of follow-up,the re-intubation rate of the observation group(13.51%,5/37)was lower than that in the control group(35.14%,13/37),P<0.05;but there was no significant

关 键 词：呼吸衰竭 序贯治疗 经鼻高流量氧疗 无创机械通气 血气分析指标 

分 类 号：R563.8[医药卫生—呼吸系统]