经鼻高流量氧疗在食管癌术后急性呼吸衰竭患者中的临床应用

Application of humidified high flow nasal cannula in respiratory failure patients post - esophagectomy for esophageal cancer

目的 探讨经鼻高流量氧疗（high flow nasal cannula， HFNC）在食管癌术后急性呼吸衰竭（acute respiratory failure，ARF）患者中的疗效。方法 回顾性分析了无锡市人民医院重症医学科（ICU）2013-04-2017-04收治的食管癌根治术后发生 ARF患者，其中2013-04-2015-04发生ARF患者均予以面罩吸氧为对照组（A组）； 2015-05-2017-04发生ARF患者均予以HFNC治疗为观察组（B组）。并记录了患者的性别、年龄、入住ICU时APACHEⅡ评分、基础肺功能、手术方式、术中出血量、氧疗前及治疗后2 h的氧合指数、面罩吸氧浓度、使用HFNC的流量及氧浓度、ICU住院时间和28 d病死率。结果 2013-04-2015-04本院共有362例患者行食管癌根治术，其中45例 （12.4%）发生ARF纳入A组，19例（42.2%）患者面罩吸氧48 h内因呼吸困难加重改为有创机械通气（IPPV）治疗； 2015-05-2017-04共有387例患者行食管癌根治术，其中 43例 （11.1%）发生 ARF纳入B组，7例 （16.2%）患者HFNC 48 h内因呼吸困难加重改为IPPV治疗。 两组年龄、性别、APACHEⅡ评分、术前第1秒钟用力呼气容积占预计值百分比（FEV1%）和术中出血量差异无统计学意义 （P均＞0.05）。A 组氧疗前氧合指数与B组比较差异无统计学意义 （t=1.658, P＞0.05）；但B组HFNC后2 h氧合指数明显高于 A组（t=3.380, P＜0.05）。B组再插管率16.2%明显低于A组再插管率42.2%，差异具有统计学意义（t=2.140, P＜0.05）。B组患者平均ICU住院时间为 （4.20±1.08） d，明显少于A组 ［（12.50±4.8） d, t=3.520, P=0.004］。B组患者死亡1例（2.3%,1/43例），明显低于A组28 d病死率（8.8%,4/45例），差异有统计学意义（t=2.95，P＜0.05）。结论 HFNC可以改善食管癌术后发生 ARF患者的氧合水平，降低患者的再插管率，缩短患者ICU住院时间，降低患者病死率。

Objective To evaluate the efficacy of humidified high flow nasal cannnla （HFNC） in acute respiratory failure （ARF） patients post - esophagectomy for esophageal cancer. Methods The patient with acute respiratory failure following esophagectomy for esophageal cancer form April 2013 to April 2017 were enrolled. From April 2013 to April 2015, the ARF patients were treated with mask oxygen -inspiration into control group （group A） ; from May 2015 to April 2017, the patients with ARF were treated by HFNC into ohservation group （ group B ）. The following factors were evaluated in two groups： gender, age, APACHE II score, FEV1% pred, intraoperative hemorrhage, the oxygenation before and two hours after HFNC therapy, the performing mode of HFNC, the level of fraction oxygenation, the length of ICU - stay and 28 - day mortality. Results There were 362 patients underwent the esophagectomy for esophageal cancer from April 2013 to April 2015, 45 patients （12.4%） who met the criterion were enrolled in group A. There were 387 patients underwent the esophagectomy for esophageal cancer from May 2015 to April 2017, 43 patients （ 11.1% ） who met the criterion were enrolled in group B. There was no significant difference in gender, APACHE II , FEV1% pred, intraoperative hemorrhage between two groups（ all P 〉 0. 05 ）. There was no significant difference in oxygenation index before HFNC therapy between group A and group B （ t = 1. 658, P 〉 0.05 ）. The oxygenation index of group B was significant higher than that of group A （ t = 3. 380, P 〈 0.05 ]. The rates of reintubation （ 16.2% ） in group B was lower thangroup A （42.2%）, and the difference was statistically significant （t = 2. 140, P 〈 0.05 ）. The length of ICU - stay in group B was significantly shorter than that in group A [ （4.20 ± 1.08 ） d vs （ 12.50 ± 4.85 ） d, t = 3. 520, P = 0.004 ]. Only one patient died finally in group B （2.3%, 1/43）. The 28 -day mortality in group B was significantly shorter than that in group A [ （ 8.8 % ,4/45 ）, t = 2.95, P 〈 0. 05 ]. Conclusion HFNC can improve the oxygenation, decrease the incidence of intubation and shorten the length of ICU - stay and the 28 - day mortality of ARF patients post - esophagectomy for esophageal cancer.