经鼻高流量氧疗在基于肺超声评估的高风险脱机患者中的应用

The role of high-flow oxygen insufflation via nasal cannula in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score

目的探讨经鼻高流量氧疗（HNFC）在基于肺超声评估的高风险脱机患者中的价值。方法选取2016年5月至2017年5月一家大学附属三级甲等综合性医院急诊ICU机械通气患者，在符合常规的脱机拔管程序基础上，患者脱机实验成功后使用肺部超声评分（LUS）进行评估，其中≥14分为高风险脱机患者（共6区域，总分为36分），将该类患者随机（随机数字法）分为两组：HNFC组和常规氧疗组（COT组）；比较HFNC组与COT组患者拔管后48h再插管率、ICU住院时间及拔管后6、24、48h患者呼吸频率、心率、氧饱和度（SaO2）、氧合指数（PaO2／FiO2）及二氧化碳分压（PaCO2）。结果共纳人符合入组标准的患者32例，其中HFNC组15例，COT组17例；脱机拔管后6hHFNC组呼吸频率、心率、氧饱和度（SaO2）、氧合指数（PaO2／FiO2）均优于COT组（P〈0．05），二氧化碳分压（PaCO2）两组差异无统计学意义（P=0．39）；脱机拔管后24、48hHFNC组SaO2、PaO2／FiO2均优于COT组（P〈0．05），呼吸频率、心率及PaCO2两组差异无统计学意义。HNFC组中拔管后48h内有1例患者重新插管（6．7％），COT组有4例患者重新插管（23．5％），两组再插管率比较有统计学意义（P〈0．01）；两组患者ICU住院时间比较：（8．0±2．4）dVS．（10．9±3．5）d，两组比较差异有统计学意义（P〈0．01）。结论针对基于肺超声筛选出的高风险脱机拔管患者中，使用经鼻高流量氧疗较常规氧疗可以改善拔管后患者的呼吸、循环及氧合情况，明显降低重新插管率，减少ICU住院时间。

Objective To study the effect of high-flow oxygen insuffiation （HFOI） via nasal cannula in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients at high risk of re-intubation after weaning from mechanical ventilation assessed by lung ultrasound score （LUS）. Methods Single center randomized（random number） clinical trial was carried out in one intensive care units in China from May 2016 to May 2017 including critically ill patients ready for planned extubation with high-risk factors for re-intubation assessed by LUS when the LUS ≥ 14 was considered to be high risk. The comparisons of the length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate pulse rate SaO2 PaO2/FiO2 of patients at 6 h, 24 h and 48 hours after extubation were made between HFOI and conventional oxygen therapy （COT） group. Results During the study period, 32 patients were enrolled in the study. Of them, 15 were assigned in HFOI group and 17 in COT group. The length of ICU stay （8.0±2.4）days vs. （10.9±3.5） days and re-intubation rate （6.7% vs. 23.5%） were significantly different between two groups （P〈0.05）. The respiratory rate pulse rate SaO2 and PaOz/FiO2 of patients at 6 h after ex-tubation in HFOI group were improved than those in COT group （P〈0.05）; and the SaO2 and PaOa/FiO2 of patients 24 h and 48 h after ex-tubation in HFOI group had much more improvement than those in COT group （P〈0.05）. Conclusion Among high-risk adults who assessed by lung ultrasound score, high-flow oxygen therapy could reduce re-intubation rate length of ICU stay and improve the respiratory fimction. High-flow oxygen therapy may offer advantages for these patients.