经鼻高流量氧疗与无创正压通气在外科术后低氧血症的治疗效果比较

Effects of high-flow nasal oxygen vs noninvasive positive airway pressure in hypoxemic patients after surgery

目的前瞻性研究经鼻高流量氧疗治疗外科术后患者合并低氧血症的临床效果。方法纳入2016年6月至2017年5月北京医院外科ICU术后低氧血症(150 mmHg≤PaO_2/FiO_2<300mmHg,PaCO_2≤50 mmHg)患者108例,按随机数字表法分为观察组(经鼻高流量氧疗组54例)和对照组(无创正压通气组54例),比较两组患者脱机后28 d再插管率和死亡率。结果两组患者拔管后28 d再插管率(11.1%vs 13.0%,P=0.767)、死亡率(5.6%vs 7.4%,P=0.696)差异无统计学意义。对比分析两组拔管前不同严重程度的低氧血症患者的临床表现(250 mmHg≤PaO_2/FiO_2<300mmHg,200 mmHg≤PaO_2/FiO_2<250 mmHg,150 mmHg≤PaO_2/FiO_2<200 mmHg),其拔管后28 d再插管率(0 vs 3.7%,P=0.296;20%vs 14.3%,P=0.684;30%vs 30.8%,P=0.968)、死亡率(0 vs3.7%,P=0.296;6.7%vs 7.1%,P=0.960;20%vs 15.4%,P=0.772)差异均无统计学意义。对照组患者面部压疮的发生率高于观察组(11.1%vs 0,P=0.012)。结论外科术后轻中度低氧血症的患者采用经鼻高流量氧疗的治疗效果不亚于无创正压通气,经鼻高流量氧疗可以安全有效的用于治疗此类术后低氧血症。

ObjectiveTo prospectively investigate the effects of high-flow nasal oxygen on hypoxemic patients after surgery. MethodsA total of 108 postoperation hypoxemic patients （150 mmHg≤PaO2/FiO2〈300 mmHg, PaCO2≤50 mmHg） in Beijing Hospital Surgical Intensive Critical Unit was included and assigned randomly to two groups from June 2016 to April 2017. Fifty four patients （study group） who received high-flow nasal oxygen therapy were compared with 54 patients （control group） who received noninvasive ventilation therapy. The data of reintubation and mortality in 28 days after extubation were collected and analyzed. ResultsNo significant differences were found for reintubation rate （11.1% vs 13.0%, P=0.767） and mortality （5.6% vs 7.4%, P=0.696） in 28 days after extubation between two groups. In subgroup analysis, no significant differences were found for different hypoxima level （250 mmHg≤PaO2/FiO2〈300 mmHg, 200 mmHg≤PaO2/FiO2〈250 mmHg and 150 mmHg≤PaO2/FiO2〈200 mmHg） between two groups, for reintubation rate （0 vs 3.7%, P=0.296; 20% vs 14.3%, P=0.684; 30% vs 30.8%, P=0.968, respectively） and mortality （0 vs 3.7%, P=0.296; 6.7% vs 7.1%, P=0.960; 20% vs 15.4%, P=0.772, respectively）. Face skin breakdown were significantly more common in control group （11.1% vs 0, P=0.012）. ConclusionsHigh-flow nasal oxygen therapy was not inferior to noninvasive ventilation for mild and moderate hypoxemic patients after surgery. High-flow nasal oxygen therapy is safe and effective for these patients.