湿化高流量鼻导管吸氧与传统鼻导管吸氧治疗老年复杂腹壁疝术后低氧血症的临床疗效  

Clinical efficacy of humidified high flow versus conventional nasal cannula oxygen inhalation on hypoxemia after complex ventral hernia surgery in elderly patients

作　　者：陈贞[1] 唐健雄[1] 李绍春 张丰 姜兆舜 孙滨海 Chen Zhen;Tang Jianxiong;Li Shaochun;Zhang Feng;Jiang Zhaoshun;Sun Binhai(Surgical Intensive Care Unit,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China)

机构地区：[1]复旦大学附属华东医院外科监护室,上海200040

出　　处：《中华消化外科杂志》2023年第9期1086-1092,共7页Chinese Journal of Digestive Surgery

基　　金：上海市疝补片不良事件监测基金(H1178);复旦大学—复星护理科研基金(FNF202077)。

摘　　要：目的探讨湿化高流量鼻导管吸氧(HFNC)与传统鼻导管吸氧治疗老年复杂腹壁疝术后低氧血症的临床疗效。方法采用回顾性队列研究方法。收集2021年1月至2022年6月复旦大学附属华东医院收治的80例老年复杂腹壁疝术后低氧血症患者的临床资料;男44例,女36例,年龄为(74±7)岁;80例患者中,40例术后采用HFNC,设为HFNC组;40例术后采用传统鼻导管吸氧,设为传统组。观察指标:(1)术后血气指标情况。(2)术后并发症情况。正态分布的计量资料以x±s表示,组间比较采用独立样本t检验;偏态分布的计量资料以M(Q_(1),Q_(3))表示,组间比较采用秩和检验。计数资料以绝对数或百分比表示,组间比较采用χ^(2)检验或Fisher确切概率法。重复测量数据采用重复测量方差分析。结果(1)术后血气指标情况。HFNC组和传统组患者术前、术后12 h、术后24 h、术后3 d动脉血氧分压分别为(13.5±2.3)kPa、(13.4±3.2)kPa、(13.8±2.3)kPa、(13.7±2.0)kPa和(12.7±2.1)kPa、(12.9±2.4)kPa、(12.3±2.5)kPa、(13.9±2.1)kPa,动脉血二氧化碳分压分别为(5.6±0.7)kPa、(5.0±0.6)kPa、(4.7±0.6)kPa、(4.9±0.6)kPa和(5.6±0.6)kPa、(4.4±0.8)kPa、(5.0±4.8)kPa、(5.1±1.1)kPa,指脉血氧饱和度分别为97.8%±2.2%、98.1%±2.1%、98.9%±1.8%、99.2%±2.0%和97.8%±3.1%、97.8%±2.1%、99.0%±1.5%、98.8%±2.0%,氧合指数分别为259±28、300±45、352±46、353±57和262±29、297±54、304±63、345±53,两组患者动脉血氧分压组间效应比较,差异有统计学意义(F组间=4.09,P<0.05),时间效应、交互效应比较,差异均无统计学意义(F时间=2.37,F交互=1.71,P>0.05);动脉血二氧化碳分压时间效应、交互效应比较,差异均有统计学意义(F时间=7.23,F交互=13.21,P<0.05),组间效应比较,差异无统计学意义(F组间=1.02,P>0.05);指脉血氧饱和度时间效应比较,差异有统计学意义(F时间=5.54,P<0.05),组间效应、交互效应比较,差异均无统计学意义(F组间=1.Objective To investigate the clinical efficacy of humidified high flow nasal cannula oxygen inhalation(HFNC)versus conventional nasal cannula oxygen inhalation on hypoxemia after complex ventral hernia surgery in elderly patients.Methods The retrospective cohort study was conducted.The clinical data of 80 elderly patients with hypoxemia after complex ventral hernia surgery who were admitted to Huadong Hospital Affiliated to Fudan University from January 2021 to June 2022 were collected.There were 44 males and 36 females,aged(74±7)years.Of the 80 patients,40 cases undergoing HFNC were allocated into HFNC group,and 40 cases undergoing conventional nasal cannula oxygen inhalation were allocated into conventional group,respectively.Observation indicators:(1)postoperative blood gas analysis;(2)postoperative complications.Measurement data with normal distribution were represented as Mean±SD,and comparison between groups was conducted using the independent sample t test.Measurement data with skewed distribution were represented as M(Q_(1),Q_(3)),and comparison between groups was conducted using the rank sum test.Count data were represented as absolute numbers or percentages,and comparison between groups was conducted using the chi-square test or Fisher exact probability.Repeated measurement data were analyzed using the repeated ANOVA.Results(1)Postoperative blood gas analysis.Before surgery and at 12 hours,24 hours,3 days after surgery,the partial pressure of blood oxygen was(13.5±2.3)kPa,(13.4±3.2)kPa,(13.8±2.3)kPa,(13.7±2.0)kPa for the HFNC group,and(12.7±2.1)kPa,(12.9±2.4)kPa,(12.3±2.5)kPa,(13.9±2.1)kPa for the conventional group.The partial pressure of carbon dioxide was(5.6±0.7)kPa,(5.0±0.6)kPa,(4.7±0.6)kPa,(4.9±0.6)kPa for the HFNC group,and(5.6±0.6)kPa,(4.4±0.8)kPa,(5.0±4.8)kPa,(5.1±1.1)kPa for the conventional group.The saturation of blood oxygen was 97.8%±2.2%,98.1%±2.1%,98.9%±1.8%,99.2%±2.0%for the HFNC group,and 97.8%±3.1%,97.8%±2.1%,99.0%±1.5%,98.8%±2.0%for the conventional group.Th

关 键 词：疝 低氧血症 老年 鼻导管吸氧 经鼻高流量湿化氧气治疗 

分 类 号：R656.2[医药卫生—外科学]