经鼻高流量吸氧用于体外循环术后患者疗效观察

Observation of nasal high- flow oxygen therapy on patients after cardiopulmonary bypass surgery

目的比较经鼻高流量吸氧（high-flow nasal cannula oxygen，HFNC）与雾化面罩吸氧对CPB术后患者肺氧合及心脏功能的影响。方法选取CPB下冠状动脉旁路移植术或换瓣手术后入住ICU的患者60例，按照随机数字表法将患者分为HFNC组（实验组）和雾化面罩吸氧组（对照组），每组30例。两组按照CPB术后临床路径进行常规治疗，拔除气管导管后实验组采用高流量吸氧湿化仪辅助通气，对照组采用雾化面罩吸氧辅助通气。观察两组患者心肺功能、临床表现、血管活性药物使用、二次插管率以及住院时间等，并予以血气分析及相关化验检查。结果实验组的SpO2、氧合指数、术后住院天数、脑钠肽（brainn atriuretic peptide，BNP）等指标均优于对照组，差异有统计学意义（P〈0．05）；实验组与对照组在二次插管率、人住ICU的时间等指标上，差异无统计学意义（P〉0．05）。结论HFNC对比雾化面罩吸氧可以明显改善CPB术后患者的心脏功能，并且可以有效预防肺部并发症发生，改善患者氧合能力。

Objective Comparing the effects of nasal catheter high- flow oxygenation with the effects of atomizing mask oxygenation on pulmonary oxygenation and cardiac function in patients who accepted CPB operation. Methods Sixty patients with intensive care unit undergoing CPB were randomly divided into high- flow oxygen group （experimental group） and traditional facial mask oxygen group （control group） according to the random number table method. Each group includes 30 patients. Two groups were treated equally according to the routine clinical measures after CPB. After cxtubation, the experimental group was assisted by high- flow oxygen inhalation humidifier, the control group was ventilated by oxygen inhalation. Cardiopulmonary function, clinical manifestations, use of vasoactive drugs, rate of secondary intubation and hospital stay were observed in both groups. Also blood gas analysis and related laboratory tests were performed. Results In the experimental group, oxygenation index, partial pressure of oxygen, length of hospital stay, brain natriuretic peptide （BNP） and cTnT were better than the values of the control group. The difference was statistically significant （P〈0.05）. There was no significant difference between the experimental group and the control group on staying time in ICU and re-intubation rate （P〉0.05）. Conclusions Compare with atomizing mask oxygen, nasal catheter high-flow oxygen can significantly improve cardiac function after CPB, effectively prevent the occurrence of pulmonary complications and improve oxygenation ability of patients.