持续湿化高流量氧疗在序贯性通气患者中的应用效果与护理

Effect and nursing of continuous humidified high flow oxygen therapy in patients with sequential ventilation

目的探讨持续湿化高流量氧疗在序贯性通气中替代无创机械通气的应用效果及护理措施。方法选择2013年1月至2015年3月序贯性通气常规行无创机械通气40例患者为对照组;选择2015年4月至2017年12月序贯性通气实行持续湿化高流量氧疗替代机械无创通气42例患者为观察组。比较两组患者无创氧疗24 h内的动脉氧分压(PaO_2)、动脉二氧化碳分压(PaCO_2)、血氧饱和度(SpO_2);评估患者治疗12h后面部皮肤变化;比较两组患者配合程度。结果两组在通气24 h内的PaO_2,PaCO_2,SpO_2比较差异均无统计学意义(P>0.05);观察组在治疗12 h后面部受压迫皮肤改变发生少于对照组,差异有统计学意义(P<0.05);观察组配合例数多于对照组,差异有统计学意义(P<0.05)。结论持续湿化高流量氧疗在序贯性通气中替代无创机械通气,保证患者的有效通气量,预防低氧血症、二氧化碳潴留,提高了患者的舒适度,减少医源性皮肤损伤。

Objective To investigated the effect and nursing method of continuous humidified high flow oxygen therapy in sequential ventilation instead of non-invasive mechanical ventilation.Methods To compared status of the arterial oxygen pressure(PaO 2),partial pressure of carbon dioxide in artery(PaCO 2),and oxygen saturation(SpO 2)under non-invasive oxygen therapy for 24 hours,changes of facial skin after treatment for 12 hours,and coordination degree,40 cases of patients with sequential ventilation,who carried out non-invasive mechanical ventilation from January 2013 to March 2015,were sampled as the control group,while 42 cases of patients with sequential ventilation,who carried out continuous humidified high flow oxygen therapy instead of non-invasive mechanical ventilation from April 2015 to December 2017,were sampled as the study group.Results There was no significant difference between the two groups in PaO 2,PaCO 2,SpO 2 within 24 hours of non-invasive oxygen therapy(P>0.05).The changes of facial skin in the study group after 12-hour's treatment by compression were less than that in the control group.The difference between the two groups had statistical significance(P<0.05).When it comes to coordination compliance,the status in the study group was better than that in the control group.The difference between the two groups also had statistical significance(P<0.05).Conclusion The replacement of non-invasive mechanical ventilation by continuous humidified high flow oxygen therapy in sequential ventilation could ensure the effective ventilation volume,prevent hypoxemia and carbon dioxide retention,improve general comfort,and reduce iatrogenic skin injury of patients.