经鼻导管高流量氧疗在肺癌根治术后呼吸衰竭患者中的临床应用

Clinical application of high-flow nasal cannula for the respiratory failure following radical resection of pulmonary carcinoma

目的 评估经鼻导管高流量氧疗（HFNC）在治疗肺癌患者术后呼吸衰竭方面的效果.方法 选择2015年2月至2016年8月行肺癌根治术后发生呼吸衰竭的48例患者,采用随机数字表法分为2组,每组24例.观察组给予HFNC,对照组给予雾化面罩8~10 L/min吸氧,分别观察2组患者治疗前及治疗后1、6、24 h和治疗结束时的心率、呼吸、PaO2、PaCO2、氧合指数（PaO2/FiO2）的变化情况,同时对比2组患者在治疗过程中进行无创正压通气（NPPV）率、再次插管机械通气率、呼吸机相关性肺炎（VAP）发生率、ICU意识模糊评估（CAM-ICU）阳性率方面以及ICU入住时间的差别.结果 治疗结束时,观察组的心率、呼吸、PaO2、PaCO2、PaO2/FiO2分别为（78.88 ± 12.03）次/min、（18.96 ± 7.53）次/min、（140.20 ± 18.37）mmHg（1 mmHg=0.133 kPa）、（37.04 ± 7.67）mmHg、（242.83 ± 27.13）mmHg,对照组分别为（88.83 ± 16.48）次/min、（25.46 ± 9.51）次/min、（86.08 ± 20.83）mmHg、（45.71 ± 10.37）mmHg、（210.71 ± 36.34）mmHg,2组比较差异有统计学意义（t=-3.922~3.415,P〈0.05）;观察组ICU入住时间为（68.71 ± 32.38）h,对照组为（107.67 ± 66.15）h,2组比较差异有统计学意义（t=2.416,P〈0.05）;观察组行NPPV率、CAM-ICU阳性率分别为16.7%（4/24）、4.2%（1/24）,对照组分别为45.8%（11/24）、33.3%（8/24）,2组比较差异有统计学意义（x2=4.752、4.923,P〈0.05）.结论 应用HFNC治疗肺癌术后呼吸衰竭较雾化面罩吸氧能更好地改善循环氧合,降低PaCO2、减少行NPPV率和CAM-ICU阳性率,且能缩短患者的ICU入住时间,是一种新而有效的氧疗方式.

Objective To evaluate the effects of the application of high-flow nasal cannula （HFNC）for the respiratory failure following radical resection of pulmonary carcinoma. Methods A total of 48 patients with radicalsurgeryofpulmonarycarcinoma effect postoperative failure from February 2015 to August 2016 were randomly divided into observation group（24 cases） and control group（24 cases） with digital table method.The observation group was received with HFNC,and the control group with oxygen atomization mask 8-10 L/min.The heart rate,respiratory rate,PaO2,PaCO2and oxygenation index（PaO2/FiO2）changes were evaluated before treatment,treatment for 1,6,24 h and at the end of the treatment in both groups, at the same time, noninvasive positive pressure ventilation （NPPV） rate, again intubation mechanical ventilation rate, incidence of ventilator associated pneumonia （VAP）, ICU confusion assessment （CAM-ICU） positive rates and ICU stay time were compared in the course of treatment of difference. Results Through two different methods of treatment, the heart rate, respiratory rate, PaO2, PaCO2,PaO2/FiO2were（78.88±12.03）times/min,（18.96±7.53）times/min,（140.2±18.37）mmHg（1 mmHg=0.133 kPa）,（37.04±7.67）mmHg,（242.83±27.13）mmHg in the observation group,respectively,compared with（88.83±16.48）times/min,（25.46±9.51）times/min,（86.08±20.83）mmHg,（45.71±10.37）mmHg and（210.71±36.34）mmHg in the control group,which had significant differences（t=-3.922-3.415,P〈0.05）. The ICU stay time in the observation group was（ 68.71 ± 32.38） h, respectively, which was much shorter than that in the contorl group（107.67±66.15） h, the difference was statistically significant （t=2.416, P〈0.05）. The occurrence rates of NPPV and the positive rates of CAM-ICU were16.7%（4/24）,4.2%（1/24）in the observation group,respectively,compared with 45.8%（11/24）,33.3%（8/24）in the control group,which had significant differences（x2=4.752,4.923,P〈0.05）. Conclusions HFNC is a new and effective way of oxygen therapy that can better improve circulation oxygenation,reduce PaCO2,reduce the rate of line of NPPV and CAM-positive rate in the ICU,and can shorten the patient＇s ICU stay time in the treatment of lung cancer patients with postoperative respiratory failure.