高流量可控氧疗不同流速联合持续加温雾化在老年重症肺炎撤机困难者中的应用  

Application of high-flow controlled oxygen therapy with different flow rates combined with continuous warming nebulization in elderly people with severe pneumonia and difficulty withdrawing

作　　者：冯丽荣[1] FENG Lirong(Beijing Changping District Hospital,Beijing 102200,China)

机构地区：[1]北京市昌平区医院,北京102200

出　　处：《中国急救复苏与灾害医学杂志》2023年第6期771-774,779,共5页China Journal of Emergency Resuscitation and Disaster Medicine

基　　金：北京市卫生科技发展专项基金(编号:2018-7-117)。

摘　　要：目的基于成功率、呼吸力学、舒适度评价高流量可控氧疗不同流速联合持续加温雾化在老年重症肺炎撤机困难者中的应用价值。方法选取2017年1月—2022年1月北京市昌平区医院100例老年重症肺炎撤机困难患者,采用随机数字表法分为40 L/min组和50 L/min组,各50例,均在ICU脱机拔管后序贯高流量可控氧疗和持续加温雾化,40 L/min组高流量可控氧疗流速为40 L/min,50 L/min组高流量可控氧疗流速为50 L/min。比较两组撤机成功率、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))、pH、氧合指数、吸气时间(Ti)、跨膈压-时间乘积(PTPdi)、呼气时间(Te)、心率、平均动脉压、呼吸频率、呼吸浅快指数、口腔干燥评分、咽喉疼痛评分、整体舒适度评分及不良反应发生率。结果40 L/min组撤机成功率(72.00%)与50 L/min组(68.00%)比较,差异无统计学意义(P>0.05);两组高流量湿化氧疗6、24 h PaO_(2)及氧合指数均高于0 h,PaCO_(2)均低于0 h(P<0.05);两组Ti、PTPdi、Te、心率、平均动脉压、呼吸频率比较,差异无统计学意义(P>0.05);40 L/min组呼吸浅快指数、口腔干燥、咽喉疼痛评分、整体舒适度评分均低于50 L/min组(P<0.05);40 L/min组不良反应发生率(2.00%)低于50 L/min组(16.00%)(P<0.05)。结论老年重症肺炎撤机困难者撤机拔管序贯40 L/min或50 L/min流速高流量湿化氧疗,均能获得良好撤机成功率,其中40 L/min流速在保证PaO_(2)、PaCO_(2)、pH、氧合指数及Ti、PTPdi、Te的前提下能更有效提高患者舒适度,且能降低不良反应发生率。Objective To evaluate the value of high-flow controlled oxygen therapy with different flow rates combined with continuous warming nebulization based on success rate,respiratory mechanics,and comfort in elderly patients with severe pneumonia who have difficulty withdrawing from the machine.Methods One hundred elderly patients with difficult withdrawal in severe pneumonia in Beijing Changping District Hospital from January 2017 to January 2022 were selected and divided into 40 L/min group and 50 L/min group,50 cases each,using the random number table method,all of whom were extubated in the ICU with sequential high-flow controlled oxygen therapy and continuous warming nebulization.The withdrawal success rate,blood gas parameters[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),pH,oxygenation index],respiratory mechanics[inspiratory time(Ti),transdiaphragmatic pressure-time product(PTPdi),expiratory time(Te)],heart rate,mean arterial pressure,respiratory rate,respiratory shallow fast index,oral dryness score,sore throat score,overall comfort score,and incidence of adverse effects.Results There was no statistically significant difference(P>0.05)between the withdrawal success rate of the 40 L/min group(72.00%)and the 50 L/min group(68.00%);the 6 h and 24 h PaO_(2) and oxygenation index of high-flow humidified oxygen therapy were higher than 0 h and PaCO_(2) was lower than 0 h in both groups(P<0.05);the differences between the two groups Ti,PTPes,PTPga PTPdi,EMGdi,Te,Pes,CVemg,Pga,CVes,Pdi,heart rate,mean arterial pressure,and respiratory rate were not statistically significant(P>0.05);shallow and fast respiratory index,oral dryness,sore throat score,and overall comfort score in the 40 L/min group were lower than those in the 50 L/min group(P<0.05);the incidence of adverse effects in the 40 L/min group(4 L/min)was lower than that in the 50 L/min group(P<0.05).The incidence of adverse reactions was lower in the 40 L/min group(2.00%)than in the 50 L/min group(16.00%)(P<0.

关 键 词：重症肺炎 撤机困难 高流量湿化氧疗 流速 呼吸力学 

分 类 号：R563.1[医药卫生—呼吸系统]