Stanford A型主动脉夹层患者术后拔除气管插管预防性给予高流量氧疗的效果评价

Evaluation of the effects of precautionary high-flow oxygen therapy in patients undergoing tracheal intubation after Stanford type A aortic dissection

目的探讨高流量氧疗方法在Stanford A型主动脉夹层术后拔除气管插管患者中的应用效果。方法选取心脏外科因Stanford A型主动脉夹层入院、术后拔除气管插管的患者,2017年1月—4月的45例为对照组,采用普通面罩式雾化器吸氧方式。2017年5月—10月的45例为试验组,采用呼吸机高流量氧疗方式。高流量氧疗组参数设置:氧浓度(FiO_2)40%~60%,氧流速35~60L/min,72h后更换为普通面罩氧疗。结果试验组的氧合指数、氧分压在测量时段较对照组均有提高,呼吸频率、二氧化碳分压在测量时段较对照组均有降低,差异有统计学意义(P<0.05);试验组在24h、48h、72h后口腔鼻腔干燥症状评分和咽喉疼痛症状评分均低于对照组,差异有统计学意义(P<0.05);试验组低氧血症发生率和二次插管发生率低于对照组(P<0.05)。结论 Stanford A型主动脉夹层术后预防性应用高流量氧疗能够提高PaO_2/FiO_2、PaO_2,降低PaCO_2、呼吸频率,减轻呼吸道不适症状,降低低氧血症、二次插管发生率。

Objective To investigate the effects of precautionary high-flow oxygen therapy on preventing hypoxemia in patients with Stanford type A aortic dissection after intubation. Methods Totally 90 hospitalized patients with Stanford type A aortic dissection in our hospital were enrolled in this study. Forty-five patients were recruited in the control group from January to April 2017,and the common mask-type nebulizer was used for oxygen inhalation. From May to October in 2017,45 patients were recruited in the experimental group. The parameters of highflow oxygen therapy in the experimental group were set as oxygen concentration（FiO2） 40%-60%,oxygen flow rate35-60L/min. Then after 72 h＇s therapy,normal mask oxygen therapy was provided as replacement therapy. Results Oxygenation index and oxygen partial pressure were increased in the experimental group than those in the control group,the rate of respiration and carbon dioxide partial pressure were decreased than those in the control group,and the differences were statistically significant（P〈0.05）.The scores of oral nasal dryness symptom and sore throat symptom in the experimental group were lower than those in the control group in 24 h,48 h,72 h during therapy,and the differences were statistically significant（P〈0.05）. The incidence of hypoxemia and the incidence of secondary intubation were lower in the experimental group than those in the control group（P〈0.05）. Conclusion Precautionary high-flow oxygen therapy for patients with Stanford type A aortic dissection can increase PaO2/FiO2,PaO2,reduce PaCO2,respiratory rate,reduce respiratory symptoms,reduce the incidence of hypoxemia,and secondary intubation.