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中华重症医学电子杂志 ›› 2021, Vol. 07 ›› Issue (02) : 115 -119. doi: 10.3877/cma.j.issn.2096-1537.2021.02.004

临床研究

不同流速经鼻高流量氧疗对有创通气患者拔管后呼吸力学的影响
陆广生1, 吴康2, 王诗雅2, 蒋振杰2, 张宝珠2, 王志敏3, 陈强2, 杨淳2, 孙庆文2, 徐远达2,()   
  1. 1. 526000 广东肇庆,广东省肇庆市第一人民医院重症医学科
    2. 510030 广州呼吸健康研究院 广州医科大学附属第一医院重症医学科
    3. 510700 广州医科大学附属第五医院重症医学科
  • 收稿日期:2020-11-15 出版日期:2021-05-28
  • 通信作者: 徐远达
  • 基金资助:
    国家临床重点专科建设项目(2011-872)

Effect of high-flow nasal oxygen therapy with different flow rates on respiratory mechanics after extubation in patients with invasive ventilation

Guangsheng Lu1, Kang Wu2, Shiya Wang2, Zhenjie Jiang2, Baozhu Zhang2, Zhimin Wang3, Qiang Chen2, Chun Yang2, Qingwen Sun2, Yuanda Xu2()   

  1. 1. Department of Critical Care Medicine, First People's Hospital of Zhaoqing, Zhaoqing 526000, China
    2. Department of Critical Care Medicine, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health,Guangzhou 510030, China
    3. Department of Critical Care Medicine, the Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou 510700, China;Corresponding auther: Xu Yuanda, Email: xuyuanda@sina.com
  • Received:2020-11-15 Published:2021-05-28
  • Corresponding author: Yuanda Xu
引用本文:

陆广生, 吴康, 王诗雅, 蒋振杰, 张宝珠, 王志敏, 陈强, 杨淳, 孙庆文, 徐远达. 不同流速经鼻高流量氧疗对有创通气患者拔管后呼吸力学的影响[J/OL]. 中华重症医学电子杂志, 2021, 07(02): 115-119.

Guangsheng Lu, Kang Wu, Shiya Wang, Zhenjie Jiang, Baozhu Zhang, Zhimin Wang, Qiang Chen, Chun Yang, Qingwen Sun, Yuanda Xu. Effect of high-flow nasal oxygen therapy with different flow rates on respiratory mechanics after extubation in patients with invasive ventilation[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2021, 07(02): 115-119.

目的

探讨经鼻高流量氧疗(HFNC)下不同流速对有创通气患者拔管后呼吸力学的影响。

方法

收集2018年12月至2020年6月在广州医科大学附属第一医院ICU住院的9例危重症患者的一般资料,其中男性6例,女性3例,年龄(67.2±14.1)岁。在拔除患者人工气道后24~48 h行3种不同流速HFNC(20、40、60 L/min)干预,通过留置多功能监测鼻胃管收集呼吸力学指标,比较不同流速HFNC对气管拔管后患者食管压(Pes)、胃内压(Pga)、跨膈压(Pdi)、食管压-时间乘积(PTPes)、胃内压-时间乘积(PTPga)、跨膈压-时间乘积(PTPdi)、膈肌肌电(EMGdi)、吸气时间(Ti)、呼气时间(Te)、食管压变异率(CVes)、肌电变异率(CVemg)、食管压与跨膈压的比值(Pes/Pdi)和跨膈压-时间乘积与食管压-时间乘积的比值(PTPdi/PTPes)等呼吸力学指标的影响。

结果

患者在HFNC流速为60 L/min和40 L/min时的EMGdi幅度均低于20 L/min时,差异有统计学意义(P<0.05),而Pes、Pga、Pdi、PTPes、PTPga、PTPdi、Ti、Te、CVes、CVemg、Pes/Pdi、PTPdi/PTPes在HFNC流速为20、40、60 L/min时,差异均无统计学意义(P>0.05)。

结论

拔除人工气道后选择流速为20、40、60 L/min的HFNC做序贯治疗对呼吸力学无明显影响,而在流速为40 L/min时,HFNC能有效改善患者肺通气,提高舒适度。

Objective

To explore the effects of different flow rates under high-flow nasal cannula on the respiratory mechanics in patients with invasive ventilation after extubation, to provide reference for clinical selection.

Methods

Nine critically ill patients who admitted in the ICU of the First Affiliated Hospital of Guangzhou Medical University, from December 2018 to June 2020 underwent three different flow rate HFNC (20, 40, 60 L/min) 24-48 h after extraction. The respiratory mechanics were measured by the indwelling multifunctional monitoring nasogastric tube. The effects of HFNC with different flow rates on the respiratory mechanics were compared.

Results

Nine patients including 3 females and 6 males, with an average age of (67.2±14.1) years old were included. Diaphragm myoelectricity (EMGdi) amplitude of HFNC at 60 L/min and 40 L/min was lower than 20 L/min (P<0.05). The esophageal pressure (Pes), gastric pressure (Pga), transdiaphragmatic pressure (Pdi), esophageal pressure-time product (PTPes), intragastric pressure-time product (PTPga), transdiaphragmatic pressure-time product (PTPdi), inspiratory time (Ti), expiratory time (Te), esophageal pressure variation rate (CVes), myoelectric variation rate (CVemg), the ratio of esophageal pressure to transdiaphragmatic pressure change (Pes/Pdi) and the ratio of transdiaphragmatic pressure-time product to esophageal pressure-time product (PTPdi/PTPes) had no significant difference at 20, 40, and 60 L/min during HFNC.

Conclusion

Choosing 20, 40, 60 L/min HFNC for sequential non-invasive adjuvant therapy after removing the artificial airway has no significant effect on respiratory mechanics. While, when the flow rate of 40 L/min, HFNC can effectively improve lung ventilation and comfort.

表1 9例患者基本资料及拔管后血气情况
表2 9例患者拔管后不同流量HFNC对呼吸力学的影响
呼吸力学指标 不同流量HFNC 统计值 P
20 L/min 40 L/min 60 L/min
Pes[cmH2O,MQ25Q75)] -4.330(-5.815,5.647) 1.087(-3.292,2.345) 0.140(-4.458,3.730) H=1.143 0.620
Pga[cmH2O,MQ25Q75)] 7.180(3.200,9.847) 7.778(4.052,10.801) 5.983(3.355,8.717) H=0.672 0.715
Pdi(cmH2O,
x¯
±s)
11.943±9.508 7.570±4.713 8.683±6.311 F=0.610 0.562
PTPes[cmH2O•s/min,MQ25Q75)] -4.873(-7.271,5.387) 1.375(-4.253,2.410) 0.244(-4.529,5.452) H=2.000 0.486
PTPga[cmH2O•s/min,MQ25Q75)] 6.820(4.889,13.788) 8.999(5.885,15.780) 6.020(4.932,13.687) H=1.143 0.620
PTPdi[cmH2O•s/min,MQ25Q75)] 11.549(5.468,23.080) 9.272(4.299,10.717) 10.702(3.633,17.290) H=2.333 0.430
EMGdi[μV,MQ25Q75)] 0.0623(0.0188,0.0698) 0.0597(0.0239,0.0693)a 0.0602(0.0245,0.0714)a H=8.194 0.010
Ti(s,
x¯
±s)
1.217±0.339 1.371±0.332 1.384±0.282 F=2.975 0.084
Te(s,
x¯
±s)
1.773±0.664 1.892±0.505 2.253±0.722 F=1.044 0.382
CVes[%,MQ25Q75)] -0.118(-0.202,0.0626) 0.131(-0.103,0.431) 0.0457(-0.129,0.609) H=3.429 0.237
CVemg(%,
x¯
±s)
0.207±0.143 0.135±0.085 0.141±0.071 F=2.505 0.117
Pes/Pdi[MQ25Q75)] -0.367(-0.510,0.761) 0.080(-0.427,0.525) -0.305(-2.978,0.054) H=2.333 0.430
PTPdi/PTPes[MQ25Q75)] -2.167(-3.821,-1.178) 1.576(-2.348,2.204) -0.807(-3.113,14.854) H=0.333 0.956
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