经鼻高流量加温湿化氧疗在心脏换瓣术后应用的疗效分析

Effect analysis of the humidifying oxygen therapy after transnasal hyperthermia

目的探讨心脏瓣膜置换术后撤离呼吸机后序贯应用经鼻高流量加温湿化氧疗(HHFNC)的有效性。方法选择2015年2月1日至2018年2月1日在该院行心脏瓣膜置换术后转重症监护病房(ICU)患者138例,将其随机分为序贯组(68例)和传统吸氧组(70例)。比较两组ICU住院时间、机械通气时间、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、序贯性器官功能衰竭评分(SOFA)、48 h再次插管率、48 h重返ICU率、呼吸频率(RR)、氧合指数(OI)、乳酸清除率(Lac)等指标。结果两组患者ICU住院时间、APACHEⅡ评分、SOFA评分、28 d病死率比较,差异均无统计学意义(P>0.05),但序贯组患者机械通气时间、48 h再次插管率、48 h重返ICU率、呼吸频率、二氧化碳分压(PCO2)均低于传统吸氧组,而氧分压(PO2)、OI、Lac均高于传统吸氧组,差异均有统计学意义(P<0.05)。结论心脏瓣膜置换术后撤离呼吸机拔出气管插管后序贯应用HHFNC可使患者机械通气时间缩短,再次插管率及重返ICU率均降低,能使患者更加安全转出ICU及降低更不良事件发生率,具有较好的应用前景。

Objective To explore the effectiveness of sequential high temperature humidified high flow nasal cannula （HHFNC） after evacuation of ventilator after cardiac valve replacement. Methods A total of 138 eases transfeiTed to ICU after heart valve replacement in the hospital fi＇om February 1,2015 to February 1,2018 were randomly divided into sequential group （68 cases） and traditional oxygen inhalation group （70 cases）. The ICU hospitalization time, mechanical ventilation time, APACHE lI score, SOFA score, 48 h re intubation rate, 48 h return to ICU rate, respiratory rate （RR）, oxygenation index （OI） and lactate clearance rate （Lac） between the two groups etc.were compared. Results The ICU hospitalization time, APACHE II score and SOFA score, the 28 d mortality rate between the two groups compared, the differences were not statis- tially signifiant （P〉0.05）, but mechanical ventilation time, 48 h reintubation rate, 48 h return to ICU rate, respiratory rate, partial pressure of carbon dioxide （PCO2） in the sequential group were lower than in those the traditional oxygen group, the partial pressure（PO2）, OI, Lac in the sequential group were higher than that of the traditional oxygen group, the differences were statis- tically significant （P〈0.05）. Conclusion After cardiac valve replacement weaning extubation after sequential application of nasal high flow warming humidification oxygen therapy in patients with mechanical ventilation time shortened, reintubation rate and return to ICU rate were reduced, which can make the patients more safely- out of ICU and reduce the incidence of adverse events, has a good application prospect.