ICU气管插管患者拔管后序贯应用经鼻高流量湿化氧疗效果观察  

Effect of nasal high flow humidified oxygen therapy on ICU tracheal intubation patients after extubation

作　　者：陈茜茜 周立杰 马宝静 张玉萍 Chen Qianqian;Zhou Lijie;Ma Baojing(Department of Respiratory and Critical Care Medicine,Jiangsu Provincial People's Hospital,Nanjing 210029,China)

机构地区：[1]江苏省人民医院(南京医科大学第一附属医院)呼吸与危重症医学科监护病房,南京210029

出　　处：《中华保健医学杂志》2025年第1期40-43,共4页Chinese Journal of Health Care and Medicine

基　　金：江苏省老年健康科研项目(LKZ2022009)。

摘　　要：目的比较ICU患者机械通气撤机后分别序贯无创正压通气(NPPV)与经鼻高流量湿化氧疗(HFNC)的有效性及安全性。方法选取江苏省人民医院2022年1月~2024年3月行气管插管机械通气患者128例,随机数表法分为HFNC组和NPPV组各64例。比较两组患者治疗2、12和24 h的氧合指数(OI)、二氧化碳分压(PaCO_(2))、呼吸频率(RR)、心率(HR)、pH值、平均动脉压(MAP)。比较两组患者再插管率、院内死亡率、不良事件发生情况及舒适度评分。结果拔管时,两组行气管插管机械通气患者RR、HR、MAP、PaCO_(2)、OI、pH值差异无统计学意义(P>0.05)。治疗2 h后,NPPV组OI(223.8±26.3)mmHg高于同时点HFNC组(207.25±28.1)mmHg,差异有统计学意义(t=3.373,P=0.001)。治疗12 h后,HFNC组RR(21.1±1.9)次∕min低于同时点NPPV组(22.3±3.2)次∕min,差异有统计学意义(t=2.574,P=0.011)。其余时点两组RR、HR、MAP、PaCO_(2)、OI、pH值差异无统计学意义(P>0.05)。HFNC组不良事件发生率10.93%低于NPPV组30.15%,差异有统计学意义(χ^(2)=7.204,P=0.007);舒适度评分(2.78±0.94)分优于NPPV组(5.64±1.31)分,差异有统计学意义(t=14.152,P=0.000)。两组患者院内再插管率、死亡率比较,差异无统计学意义(P>0.05)。结论机械通气患者脱机拔管后序贯经鼻高流量湿化氧疗效果与无创正压通气相似,但HFNC具有降低并发症、提高患者舒适度的优势。Objective To compare the effectiveness and safety of sequential non-invasive positive pressure ventilation(NPPV)and nasal high flow humidified oxygen therapy(HFNC)in ICU patients after mechanical ventilation withdrawal.Methods 128 patients who underwent mechanical ventilation with endotracheal intubation from January 2022 to March 2024 were randomly divided into HFNC group and NPPV group,with 64 patients in each group.Compare the oxygenation index(OI),partial pressure of carbon dioxide(PaCO_(2)),respiratory rate(RR),heart rate(HR),pH value,and mean arterial pressure(MAP)of two groups treated for 2 hours,12 hours,and 24 hours.Compare the intubation rate,in-hospital mortality rate,incidence of adverse events,and comfort score between two groups.Results At extubation,there were no statistically significant differences in RR,HR,MAP,PaCO_(2),OI,and pH values between the groups of patients undergoing mechanical ventilation with endotracheal intubation(P>0.05).After 2 hours of treatment,the OI was(223.8±26.3)mmHg in the NPPV group which higher than the(207.25±28.1)mmHg in the HFNC group at the same time point(t=3.373,P=0.001).After 12 hours of treatment,the RR was 21.1±1.9 times∕min in the HFNC group which lower than the 22.3±3.2 times∕min in the NPPV group at the same time point(t=2.574,P=0.011).After 2 hours of treatment,the OI was(223.8±26.3)mmHg in the NPPV group which higher than the(207.25±28.1)mmHg in the HFNC group at the same time point(t=3.373,P=0.001).At other time points,there was no statistically significant difference in RR,HR,MAP,PaCO_(2),OI,and pH values between the two groups(P>0.05).The incidence of adverse events in the HFNC group was 10.93%,which was lower than that in the NPPV group(30.15%),with statistically significant differences(χ^(2)=7.204,P=0.007).The comfort score was(2.78±0.94),which was better than that in the NPPV group(5.64±1.31),with statistically significant differences(t=14.152,P=0.000).Conclusion There is no statistically significant difference in the effect of oxygen the

关 键 词：经鼻高流量湿化氧疗 重症监护 拔管 无创正压通气 

分 类 号：R563[医药卫生—呼吸系统]