经鼻高流量湿化氧疗对COPD患者拔管后再插管及呼吸衰竭的影响

Effect of Humidified High Flow Nasal Cannula on Reintubation and Respiratory Failure after Extubation in COPD Patients

目的:探讨经鼻高流量湿化氧疗(HHFNC)对慢性阻塞性肺疾病(COPD)患者拔管后再插管及呼吸衰竭的影响。方法:选择ICU 86例COPD合并急性呼吸衰竭患者作为研究对象,按照随机原则分为对照组和观察组各43例。对照组拔管后给予无创呼吸机辅助呼吸,观察组拔管后接受HHFNC。观察并比较两组拔管后血气情况、ICU停留时间、再次插管率及拔管至再次插管时间。结果:拔管后6 h和12 h观察组动脉血氧分压(Pa O2)、动脉血二氧化碳分压(Pa CO2)、心率(HR)和呼吸频率(RR)与对照组比较差异均有统计学意义(P<0.05)。观察组ICU停留时间、再次插管率、拔管后呼吸衰竭发生率和拔管至再次插管时间与对照组比较差异有统计学意义(P<0.05)。结论:HHFNC能明显改善COPD患者拔管后的氧合状况,降低再次插管率及缩短ICU住院时间。

Objective： To discuss the influence of humidified high flow nasal cannula on reintubation after extubation and respiration failure in patients with chronic obstructive pulmonary disease（ COPD）. Methods： A total of 86 ICU cases of COPD combined with acute respiratory failure were selected as the research subject. According to the random principle,they were divided into the control group and the observation group,43 in each group. After extubation,the control group was given a noninvasive breathing ventilator,and the observation group received HHFNC after extubation. The blood gas status,ICU retention time,reintubation rate and the time of extubation to reintubation after the first extubation were observed and compared between the two groups. Results： There were statistically significant differences in arterial oxygen pressure（ Pa O2）,arterial carbon dioxide partial pressure（ Pa CO2）,heart rate（ HR） and respiratory rate（ RR） between the observation group and the control group at 6 h and 12 h after extubation（ P〈0. 05）. Conclusion： HHFNC can obviously improve the oxygenation status of COPD patients after extubation,reduce the rate of reintubation and the time of hospitalization in ICU.