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中华重症医学电子杂志 ›› 2018, Vol. 04 ›› Issue (03) : 257 -261. doi: 10.3877/cma.j.issn.2096-1537.2018.03.009

所属专题: 文献

临床研究

经鼻高流量氧疗对急性呼吸衰竭患者的序贯治疗
陈新龙1, 赵宏胜1,(), 王林华1, 陆洋1, 彭清云1   
  1. 1. 226001 南通大学附属医院重症医学科
  • 收稿日期:2018-03-15 出版日期:2018-08-28
  • 通信作者: 赵宏胜

Sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure

Xinlong Chen1, Hongsheng Zhao1,(), Linhua Wang1, Yang Lu1, Qingyun Peng1   

  1. 1. Department of Critical Care Medicine, Affiliated Hospital of Nantong University, Nantong 226001, China
  • Received:2018-03-15 Published:2018-08-28
  • Corresponding author: Hongsheng Zhao
  • About author:
    Corresponding author: Zhao Hongsheng, Email:
引用本文:

陈新龙, 赵宏胜, 王林华, 陆洋, 彭清云. 经鼻高流量氧疗对急性呼吸衰竭患者的序贯治疗[J/OL]. 中华重症医学电子杂志, 2018, 04(03): 257-261.

Xinlong Chen, Hongsheng Zhao, Linhua Wang, Yang Lu, Qingyun Peng. Sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2018, 04(03): 257-261.

目的

探讨经鼻高流量氧疗(HFNC)用于急性呼吸衰竭患者序贯治疗的临床效果。

方法

选取2016年1月至2017年12月因急性呼吸衰竭入住南通大学附属医院重症医学科行有创机械通气的患者,在撤离呼吸机拔除气管插管后仍存在低氧状态者入选本研究。随机分为对照组44例,高流量组45例。对照组给予常规氧疗方式(鼻导管、面罩),高流量组则采用经鼻高流量氧疗。比较2组患者拔除气管插管后1、8、24 h的呼吸频率、氧合指数(PaO2/FiO2)、动脉血氧饱和度(SaO2)、二氧化碳分压(PaCO2);比较2组患者拔除气管插管后氧疗舒适度、耐受性,无创机械通气使用率,48 h再插管率的差异。

结果

高流量组患者的呼吸频率低于对照组,差异具有统计学意义[1 h:(20.6±3.2)次/分 vs (24.5±3.7)次/分;8 h:(21.5±3.6)次/分 vs (20.6±3.2)次/分;24 h:(20.9±3.4)次/分 vs (24.9±4.2)次/分,均P<0.05],PaO2/FiO2及SaO2高于对照组,差异具有统计学意义[PaO2/FiO2:1 h:(241.5±32.6) mmHg vs (213.5±30.7)mmHg;8 h:(252.5±28.6)mmHg vs (228.1±30.7)mmHg;24 h:(261.5±32.6)mmHg vs (230.5±30.7)mmHg;SaO2:1 h:(96.7±3.6)% vs (92.6±4.3)%;8 h:(96.3±3.8)% vs (93.2±4.3)%;24 h:(96.4±3.6)% vs (93.3±3.9)%;均P<0.05],舒适度和耐受性优于对照组,差异具有统计学意义[(4.1±0.4)分 vs (3.1±0.4)分;(3.0±0.3)分 vs (1.4±0.3)分,均P<0.05],无创机械通气率低于对照组,差异具有统计学意义(24.4% vs 45.4%,P<0.05),2组患者48 h再插管率比较,差异无统计学意义(11.1% vs 13.6%,P>0.05)。

结论

经高流量氧疗可更好地改善急性呼吸衰竭患者气管插管拔除后的低氧状态,且有更好的舒适度和耐受性,并能降低患者无创机械通气使用率,可用于急性呼吸衰竭患者拔除气管插管后的序贯治疗。

Objective

To determine the efficacy of sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure.

Methods

Acute respiratory failure patients admitted to department of Crititcal Care Medicine of Affiliated Hospital of Nantong University who received mechanical ventilation from January 2016 to December 2017 were enrolled in this study. After extubation, 44 patients were randomly divided into control group while 45 others in high flow oxygen group. The control group was given conventional oxygen therapy (nasal catheter or mask), and high flow group was treated with high-flow nasal cannula oxygen. Respiratory rate, PaO2/FiO2, SaO2 and PaCO2 of patients at 1h, 8h and 24h after extubation between two groups were recorded. We also recorded the comfort level and tolerance of oxygen therapy, the proportion of noninvasive ventilation and re-intubation between two groups.

Results

The respiratory rate ( per minute) was significantly lower in the high-flow oxygen group [1 h: (20.6±3.2) times/min vs (24.5±3.7) times/min; 8 h: (21.5±3.6) times/min vs (20.6±3.2) times/min; 24 h: (20.9±3.4) times/min vs (24.9±4.2) times/min, all P<0.05] relative to control group. Compare to control therapy, PaO2/FiO2 and SaO2 were significantly higher in the high-flow oxygen group [PaO2/FiO2: 1 h: (241.5±32.6) mmHg vs (213.5±30.7) mmHg; 8 h: (252.5±28.6) mmHg vs (228.1±30.7) mmHg; 24 h: (261.5±32.6) mmHg vs (230.5±30.7) mmHg; SaO2:1 h: (96.7±3.6)% vs (92.6±4.3)%; 8 h: (96.3±3.8)% vs (93.2±4.3)%; 24 h: (96.4±3.6)% vs (93.3±3.9)%; all P<0.05]. Patients had better comfort and tolerance with high-flow nasal oxygen therapy compared to that in control group [(4.1±0.4) scores vs (3.1±0.4) scores; (3.0±0.3) scores vs (1.4±0.3) scores, all P<0.05]. In addition HFNC could reduce the needs for noninvasive ventilation (24.4% vs 45.4%, P<0.05). However, no significant differences were found in the re-intubation rate between two groups (11.1% vs 13.6%, P>0.05).

Conclusion

In patients with acute respiratory failure after extubation, treatment with high-flow oxygen can improveoxygenationwith better comfort and tolerance. Also it can reduce the use of noninvasive mechanical ventilation in patients. The findings support the use of high-flow nasal oxygen therapy as sequential therapy after extubation in patients with acute respiratory failure.

表1 2组急性呼吸衰竭患者氧疗后1 h的RR、SaO2、PaO2/FiO2、PaCO2比较(±s
表2 2组急性呼吸衰竭患者氧疗后8 h的RR、SaO2、PaO2/FiO2、PaCO2比较(±s
表3 2组急性呼吸衰竭患者氧疗后24 h的RR、SaO2、PaO2/FiO2、PaCO2比较(±s
表4 2组急性呼吸衰竭患者氧疗的舒适度、耐受性的比较(分,±s
表5 2组急性呼吸衰竭患者无创机械通气率及48 h内再插管率的比较
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