经鼻高流量氧疗与传统氧疗在急性中型颅脑损伤患者中的应用效果比较  

Comparisons of application effects of high-flow nasal cannula oxygen therapy and traditional oxygen therapy in patients with acute moderate traumatic brain injury

作　　者：张述升[1] 刘俊[1] 陈悦达[1] 孙静 王小华[1] 张国斌[1] Zhang Shusheng;Liu Jun;Chen Yueda;Sun Jing;Wang Xiaohua;Zhang Guobin(Department of neurosurgery,Tianjin Huanhu Hospital,Tianjin 300350,China)

机构地区：[1]天津市环湖医院神经外科颅脑创伤与神经重症,天津300350

出　　处：《中国中西医结合急救杂志》2023年第1期42-45,共4页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：天津市医学重点学科(专科)建设项目(TJYXZDXK-022A)。

摘　　要：目的比较经鼻高流量氧疗(HFNC)与传统氧疗在改善急性中型颅脑损伤患者缺氧状态中的差异,探讨HFNC在急性脑外伤患者气道管理中的应用价值。方法选择2020年6月至11月天津市环湖医院颅脑损伤抢救中心收治的急性中型颅脑损伤〔格拉斯哥昏迷评分(GCS)9~12分〕患者作为研究对象,按照纳入和排除标准,最终58例患者纳入分析。按氧疗模式将患者分为传统氧疗组(36例)和HFNC组(22例)。比较两组患者治疗前及治疗后12、24、48 h的心率(HR)、平均动脉压(MAP)、呼吸频率(RR)、脉搏血氧饱和度(SpO_(2))、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、pH值、氧合指数的差异;并观察治疗7 d内两组患者气管插管率和重症监护病房(ICU)住院时间等的变化。结果两组患者性别、年龄和入院时GCS评分比较差异均无统计学意义(均P>0.05)。与传统氧疗组比较,治疗后24 h起HFNC组RR明显降低,并持续到48 h(次/min:24 h为17.50±4.26比21.14±4.81,48 h为17.54±2.18比20.25±2.69,均P<0.05)。治疗后12 h起HFNC组SpO_(2)、PaO_(2)均较治疗前明显升高〔SpO_(2):12、24、48 h分别为0.99±0.01比0.98±0.02,0.99±0.02比0.97±0.02,0.99±0.01比0.97±0.02;PaO_(2)(mmHg,1 mmHg≈0.133 kPa):12、24、48 h分别为85.23±7.16比75.08±7.73,91.55±8.88比73.81±8.32,95.27±5.75比76.22±6.43,均P<0.05〕,PaCO_(2)明显降低(mmHg:12、24、48 h分别为38.27±4.50比42.39±5.68,38.91±4.86比42.75±7.64,37.09±2.97比42.14±3.53,均P<0.05)。pH值除治疗48 h HFNC组明显高于传统氧疗组外(7.42±0.02比7.37±0.03,P<0.05),其余各时间点比较差异均无统计学意义;而氧合指数从治疗12 h开始则持续高于传统氧疗组(mmHg:12、24、48 h分别为482.32±33.41比424.32±35.09,519.19±27.68比420.22±34.20,529.30±31.95比425.00±33.98,均P<0.05)。HFNC组7 d内插管率低于传统氧疗组,但差异无统计学〔4.5%(1/22)比11.1%(4/36),P>0.05〕,但ICU住院时间较传统氧疗组明显Objective To compare the differences between high-flow nasal cannula oxygen therapy(HFNC)and traditional oxygen therapy(COT)in improving the hypoxic state of patients with acute moderate traumatic brain injury(TBI),and to explore the application value of HFNC in these patients.Methods This study was executed to analyze patients with acute moderate TBI[Glasgow coma scale(GCS)9-12]admitted to the Brain Injury Care Center of Tianjin Huanhu Hospital from June 2020 to November 2020.According to the inclusion and exclusion criteria,58 patients were finally included in the analysis.All patients were divided into two groups according to the modes of oxygen therapy.36 patients were in the COT group,and 22 patients were in the HFNC group.The differences of heart rate(HR),mean arterial pressure(MAP),respiratory rate(RR),blood oxygen saturation(SpO_(2)),arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),pH value and oxygenation index that from blood gas analysis between two groups were compared and analyzed before(T0 h)and after(T12 h,T24 h,T48 h)the treatments.The rate of tracheal intubation within 7 days and the length of stay in the intensive care unit(ICU)were both compared and analyzed.Results There were no statistically significant differences in gender,age,and GCS score at admission between the two groups(all P>0.05).RR of the HFNC group was lower than that in the COT group from 24 hours after treatments and continued to 48 hours(per minute:at T24 h 17.50±4.26 vs.21.14±4.81,at T48 h 17.54±2.18 vs.20.25±2.69,both P<0.05).From 12 hours,the SpO_(2)and PaO2 of the HFNC group were both better than those of the COT group[SpO2:at T12 h 0.99±0.01 vs.0.98±0.02,at T24 h 0.99±0.02 vs.0.97±0.02,at T48 h 0.99±0.01 vs.0.97±0.02;PaO_(2)(mmHg,1 mmHg≈0.133 kPa):at T12 h 85.23±7.16 vs.75.08±7.73,at T24 h 91.55±8.88 vs.73.81±8.32,at T48 h 95.27±5.75 vs.76.22±6.43,all P<0.05].PaCO_(2)was decreased(mmHg:at T12 h 38.27±4.50vs.42.39±5.68,at T24 h 38.91±4.86 vs.42.75±7.64,

关 键 词：颅脑损伤 经鼻高流量吸氧 气道管理 

分 类 号：R459.6[医药卫生—治疗学]