经鼻高流量湿化氧疗治疗肺移植术后移植物失功患者的临床研究

A Clinical Study on Humidified High Flow Nasal Cannula Therapy for Patients with Primary Graft Dysfunction after Lung Transplantation

目的:探讨经鼻高流量湿化氧疗系统(Humidified High Flow Nasal Cannula,HFNC)治疗肺移植术后原发性移植物失功的治疗效果。方法:选取2015年1月1日至2016年12月31日在我院行肺移植手术后出现原发性移植物的患者48例,并将其随机分为两组,分别应用HFNC或NPPV进行治疗,比较两组患者不同时间点(入组当时、入组后24、48、72小时)的氧合指数Pa O_2/Fi O_2、再插管率、气管切开率、呼吸机相关性肺炎(VAP)的发生率、病死率及ICU住院时间。结果:入组后24、48、72小时,HFNC组氧合指数Pa O_2/Fi O_2均明显高于NPPV组(P<0.05),再次插管率、气管切开率、VAP发生率均显著低于NPPV组(P<0.05)。患者ICU住院时间较NPPV组明显缩短(P<0.05),住院病死率显著低于NPPV组,但两组差异无统计学意义(P>0.05)。结论:在掌握应用指征的前提下,HFNC治疗肺移植术后移植物失功患者可有效改善其氧合和预后。

Objective： To investigate the therapeutic effect of Humidified High Flow Nasal Carmula （HFNC） on the primary graft failure after lung transplantation. Methods： Forty-eight patients with primary grafts who underwent lung transplantation from January 1, 2015 to December 31, 2016 were randomly divided into two groups： HFNC or NPPV （P 〈0.05）. The oxygenation index PaO2/FiO2, re-intubation rate, tracheotomy rate, ventilator-associated pneumonia （VAP） were compared between the two groups at different time points （at 24, 48, 72 hours after admission）, the mortality and ICU hospital stay were also compared. Results： The PaO2/FiO2 of HFNC group was significantly higher than that of the NPPV group at 24, 48 and 72 hours after admission （P〈0.05）, and the rate ofintubation, tracheotomy rate and VAP were significantly lower than NPPV Group （P〈0.05）. The hospitalization time of ICU was significantly shorter than that of the NPPV group （P〈0.05）. The hospital mortality was significantly lower than that of NPPV group, but there was no significant difference between the two groups （P〉0.05）. Conclusion： HFNC can effectively improve the oxygenation and prognosis of patients with graft failure after lung transplantation under the premise of mastery of application indications.