机械通气撤离序贯治疗中应用HFNC对重症肺炎患者的临床效果  

Clinical effect of HFNC in mechanical ventilation evacuation sequential therapy for patients with severe pneumonia

作　　者：陆逸倩 张玲 曹玲 王强 LU Yiqian;ZHANG Ling;CAO Ling;WANG Qiang(Respiratory and Thoracic Surgery,Chongming Hospital Affiliated to Shanghai Medical College of Health,Shanghai 202150,China)

机构地区：[1]上海健康医学院附属崇明医院呼吸胸外科,上海202150

出　　处：《新疆医科大学学报》2024年第1期57-61,共5页Journal of Xinjiang Medical University

基　　金：上海市科技计划项目(19Y11392821)。

摘　　要：目的探讨机械通气撤离序贯治疗中应用经鼻高流量湿化氧疗(High flow nasal cannula,HFNC)对重症肺炎患者的临床效果,并分析该方案对患者撤离24 h后痰液湿化与动脉血氧分压的影响。方法选取2019年1月-2022年12月118例上海健康医学院附属崇明医院收治的重症肺炎患者,采用随机数字表法将其分为对照组和试验组,各59例,对照组患者接受无创正压通气,试验组患者接受HFNC,比较两组患者临床指标(总机械通气时间、住院时间)、撤离24 h后痰液湿化效果、痰液黏稠度、血气指标[动脉血氧分压(PaO_(2))]、二氧化碳分压(PaCO_(2))、生命体征(呼吸频率、心率)、再插管率、不良反应发生情况。结果试验组患者总机械通气时间和住院时间均短于对照组(P<0.05)。试验组湿化满意率(81.36%)较对照组(49.15%)高,差异有统计学意义(P<0.05)。试验组中痰液黏稠度Ⅰ度、Ⅱ度和Ⅲ度患者分别为31例(52.54%)、24例(40.68%)和4例(6.78%),与对照组患者痰液黏稠度之间差异有统计学意义(P<0.05)。治疗后,两组患者PaO_(2)均上升,PaCO_(2)均下降,且试验组PaO_(2)显著高于对照组,PaCO_(2)显著低于对照组(P<0.05);两组患者呼吸频率和心率均下降,且试验组呼吸频率和心率均显著低于对照组(P<0.05)。试验组患者再插管率(3.39%)较对照组(18.64%)低,不良反应发生率(8.47%)较对照组(32.20%)低,差异有统计学意义(P<0.05)。结论在机械通气撤离序贯治疗中给予重症肺炎患者HFNC治疗能促进患者恢复,改善患者撤机后24 h的痰液湿化效果、痰液黏稠度、患者血氧状态和生命体征,降低不良反应发生率和再插管率。Objective To investigate the clinical efficacy of high flow nasal cannula(HFNC)in sequential mechanical ventilation evacuation therapy for severe pneumonia patients,and to analyze the impact of the regimen on sputum humidification and arterial oxygen partial pressure after 24 hours of evacuation.Methods A total of 118 severe pneumonia patients admitted to Chongming Hospital Affiliated to Shanghai Medical College of Health from January 2019 to December 2022 were selected.The patients were randomly divided into a control group and an experimental group,with 59 patients in each group using a random number table method.The control group received non-invasive positive pressure ventilation,while the experimental group received HFNC.Clinical indicators(total mechanical ventilation time,hospital stay),sputum wetting effect after 24 hours of evacuation,and sputum viscosity were compared between the 2 groups blood gas indicators[arterial oxygen partial pressure(PaO_(2)),carbon dioxide partial pressure(PaCO_(2)),vital signs(respiratory rate,heart rate),reintubation rate,incidence of adverse reactions].Results The total mechanical ventilation time and hospitalization time of the experimental group patients were shorter than those of control group(P<0.05).The satisfaction rate of humidification in the experimental group(81.36%)was higher than that in control group(49.15%),and the difference was statistically significant(P<0.05).In the experimental group,there were 31 patients(52.54%),24 patients(40.68%)and 4 patients(6.78%)with sputum viscosity of gradeⅠ,Ⅱ,andⅢ,respectively.The difference in sputum viscosity between the experimental group and the control group was statistically significant(P<0.05).After thetreatment,both groups of the patients had an increase in PaO_(2)and a decrease in PaCO_(2),and the experimental group had significantly higher PaO_(2)than the control group,while PaCO_(2)was significantly lower than the control group(P<0.05).After thetreatment,the respiratory rate and heart rate of both groups of the

关 键 词：机械通气撤离序贯治疗 经鼻高流量湿化氧疗 重症肺炎 痰液湿化 动脉血氧分压 

分 类 号：R563.1[医药卫生—呼吸系统]