经鼻高流量湿化氧疗在爆震伤患者中的应用

The clinical application of high-flow nasal cannula humidified oxygen therapy in patients with blast injury

目的探讨经鼻高流量（HFNC）湿化氧疗在爆震伤患者中的应用效果。方法回顾性分析天津市第五中心医院重症医学科2015年8月12日至30日收治的“8-12”爆震伤患者的临床资料。以12例应用HFNC湿化氧疗系统进行气道湿化者为观察组，以9例应用传统人工面罩气道湿化法治疗者为对照组，两组患者均未应用机械通气。观察24h后两组患者心率（HR）、平均动脉压（MAP）、呼吸频率（RR）及动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、脉搏血氧饱和度（SpO2）的变化，并比较两组患者的湿化效果。结果观察组和对照组HR和MAP比较差异均无统计学意义[HR（次／min）：85．7±14．5比95．2±13．6，MAP（mmHg，1mmHg=0．133kPa）：81-3±7．3比83．1±6．6，均P〉0．05]。观察组RR、PaCO2较对照组明显降低[RR（次／min）：22．4±3．5比27．8±3．2，PaCO2（mmHg）：36．4±4．4比43．2±5．6]，pH值、PaO2、SpO2均较对照组明显升高[pH值：7．45±0．40比7．35±0．30，PaO2（mmHg）：160．7±42．2比79．8±12．9，SpO2：0．983±0．014比0．933±0．023。P〈0．05或P〈0．01]。观察组患者湿化满意率优于对照组[100．0％（12／12）比44．4％（4／9），P〈0．05]。结论HFNC湿化氧疗可以有效改善爆震伤患者的氧合，减少二氧化碳（CO2）潴留，湿化效果优于传统人工面罩气道湿化法。

Objective To explore the efficacy of humidified oxygen therapy via high-flow nasal cannula （HFNC） in treatment of blast injury patients. Methods A retrospective study was conducted in department of critical care medicine of Tianjin Fifth Center Hospital from August 12 to 30, 2015, and the patients＇ clinical data were collected from the ＂8 - 12＂ explosion accident in Tianjin. Twelve patients treated with HFNC humidified oxygen therapy were in observation group, and 9 with traditional artificial airway humidification were in the control group. All patients did not use mechanical ventilation. The changes of heart rate （HR）, mean arterial blood pressure （MAP）, respiratory rate （RR）, arterial partial oxygen pressure （PaO2）, arterial partial carbon dioxide pressure （PaCO2） and saturation of pulse oximetry （SpO2） were observed respectively after humidification for 24 hours, and the therapeutic effects of humidification in the two groups were compared. Results There were no statistical significant differences in HR and MAP compared between observation group and control group [HR （bpm）： 85.7 ± 14.5 vs. 95.2± 13.6, MAP （mmHg, 1 mmHg = 0.133 kPa）： 81.3 ± 7.3 vs. 83.1 ± 6.6, both P 〉 0.05]. The RR, PaCO2 in observation group were obviously lower than those of the control group [RR （bpm）： 22.4 ± 3.5 vs. 27.8 ± 3.2, PaCO2 （mmHg）： 36.4 ± 4.4 vs. 43.2 ± 5.6] and pH value, PaO2, SpO2 in observation group were all markedly higher than those of the control group [pH value： 7.45 ± 0.40 vs. 7.35 ± 0.30, PaO2 （mmHg）： 160.7 ± 42.2 vs. 79.8 ± 12.9, SpO2 （mmHg）： 0.983 ± 0.014 vs. 0.933±0.023, P 〈 0.05 or P 〈 0.01]. The rate of satisfaction of humidification in observation group was superior to that in control group [100.0% （12/12） vs. 44.4% （4/9）, P 〈 0.05]. Conclusions HFNC humidified oxygen therapy can effectively improve the oxygenation of patients with blast injury, decrease the retention of carbon dioxide, and the efficacy of the humidification is superior to the traditional artificial airway humidification.