高流量T管氧疗在辅助神经重症气管切开机械通气患者撤机的应用研究

Application of high-flow T-tube oxygen therapy in assisting weaning of patients with neurocritical tracheotomy and mechanical ventilation

目的探讨高流量T管氧疗对气管切开术后行机械通气并且符合撤除机械通气条件的神经重症患者的氧疗效果,特别是在控制气道温湿度、促进痰液稀释及降低术后并发症方面的作用。方法收集2019年9月—2021年9月四川大学华西医院诊治的50例气管切开术后行机械通气并且符合撤除机械通气条件的神经重症患者。根据呼吸治疗师决定的撤机后氧疗方式将患者分为三组:高流量T管组(n=16)、人工鼻组(n=26)和高流量接头组(n=8)。收集三组患者撤机前及撤机后72 h的生命体征、呼吸困难程度和血气分析指标,每日气道分泌物的性状、量、黏稠度,以及人工气道通畅情况;比较分析三组患者机械排痰、体位引流、化痰药物使用情况,气道相关事件(人工气道堵塞、人工鼻堵塞、肺部感染)发生情况,以及住ICU时间和ICU死亡情况。结果50例患者中男28例,女22例;三组患者的年龄、体重、身高、性别、指脉氧饱和度、心率、急性生理学和慢性健康状况评价Ⅱ评分、序贯器官衰竭评分、格拉斯哥昏迷评分差异无统计学意义(均P>0.05)。三组患者撤机后72 h痰液性状(Ⅰ度)存在显著差异(P=0.006)。三组患者72 h机械排痰次数及化痰药物使用差异无统计学意义(P=0.113,P=1.00)。结论对气管切开术后行机械通气并且符合撤除机械通气条件的神经重症患者使用高流量T管氧疗,可有效控制气道温湿度,促进痰液稀释利于引流,从而减少气管切开术后并发症。

Objective To explore the oxygen therapy effects of high-flow T-tube oxygen therapy on neurointensive care patients who have undergone tracheostomy and are undergoing mechanical ventilation while meeting the criteria for weaning from mechanical ventilation,especially in terms of controlling airway temperature and humidity,promoting mucus dilution,and reducing postoperative complications.Methods Collected data from 50 neurointensive care patients who underwent tracheostomy and were on mechanical ventilation,meeting the criteria for weaning from mechanical ventilation,treated at West China Hospital of Sichuan University from September 2019 to September 2021.The three groups of patients had different weaning methods:a high-flow T-tube for weaning,a heat and moisture exchanger(artificial nose)for weaning,and a high-flow tracheal joint for weaning.The vital signs,dyspnea and blood gas analysis before and three days after weaning were collected.The primary outcomes were mechanical sputum excretion,postural drainage,phlegm-resolving drugs use,airway-related events(artificial airway blockage,artificial nose blockage,lung infection),stay in ICU(days),and death in ICU.Results Among the 50 patients,28 were males and 22 were females.There were no significant differences in age,weight,height,gender,finger pulse oxygen saturation,heart rate,APACHEII score,sequential organ failure assessment,or Glasgow coma scale among the three groups(P>0.05).There was no statistical difference in the number of 72-hour mechanical sputum excretion or the use of phlegm-resolving drugs in the three groups(P=0.113,P=1.00).Conclusion The use of high-flow T-tube oxygen therapy in neurointensive care patients who have undergone tracheostomy,are on mechanical ventilation,and meet the criteria for weaning from mechanical ventilation can effectively control airway temperature and humidity,promote mucus dilution for better drainage,thereby reducing post-tracheostomy complications.