经鼻高流量氧疗在颈椎损伤伴高位截瘫患者术后脱机中的应用

The role of high-flow nasal cannula oxygen therapy in patients with high cervical spinal cord injury

目的探讨经鼻高流量氧疗(HNFC)在颈椎损伤伴高位截瘫患者术后脱机中的价值。方法回顾性分析2016年9月至2018年3月中一家大学附属三级甲等综合性医院急诊ICU颈椎损伤伴高位截瘫并进行手术患者,术后在符合常规的脱机拔管程序基础上进行脱机拔管,比较使用高流量氧疗(HNFC)组和常规氧疗组(COT组)对患者拔管后72 h再插管率、ICU住院时间及拔管后6、24、72 h患者呼吸频率、心率、平均动脉压(MAP)氧饱和度(SaO2)、氧合指数(PaO2/FiO2)及二氧化碳分压(PaCO2)。结果共纳入符合入组标准的患者38例,其中HFNC组16例,COT组22例;脱机拔管后6 h HFNC组患者呼吸频率、氧饱和度(SaO2)、氧合指数(PaO2/FiO2)均优于COT组(P<0.05),患者心率、平均动脉压(MAP)、血气分析中二氧化碳分压(PaCO2)两组差异无统计学意义(P=0.39);脱机拔管后24 h、72 h HFNC组PaO2/FiO2优于COT组(P<0.05),HFNC组患者PaCO2值显著小于COT组(P<0.05),脱机拔管后24h血氧饱和度(SaO2)HFNC组优于COT组(P<0.05),但72 h血氧饱和度(SaO2)两组差异无统计学意义(P=0.21)、呼吸频率、心率及平均动脉压(MAP)两组两个时间点差异无统计学意义。HNFC组中拔管后72 h内有3例患者重新插管(18.8%),COT组有6例患者重新插管(27.3%),两组再插管率比较差异有统计学意义(P<0.05);两组患者ICU住院时间比较:(15.5±3.4) d vs (16.6±5.2) d,差异无统计学意义。结论针对基于颈椎损伤伴高位截瘫患者术后脱机拔管患者中,使用经鼻高流量氧疗较常规氧疗可以改善拔管后患者的呼吸及氧合情况,降低拔管患者24、72 h的PaCO2,明显降低患者重新插管率,但并不减少ICU的住院时间。

Objective To study the effect of high-flow nasal cannula oxygen therapy (HFNC) in reduction in re-intubation rate, length of ICU stay and improvement of respiratory function in patients with high cervical spinal cord injury. Methods Single center retrospective study was carried out in our intensive care unit from September 2016 to March 2018. Post-operative patients ready for planned extubation with high cervical spinal cord injury were included. The length of ICU stay, re-intubation rate in case of respiratory failure, respiratory rate, pulse rate, MAP, SaO2, PaO2/FiO2, and PaCO2 of patients at 6, 24 and 72 h after extubation were compared between the HFNC and conventional oxygen therapy (COT) groups. Results During the study period, 38 patients were enrolled in the study. Of them, 16 patients were assigned in the HFNC group and 22 patients in the COT group. Re-intubation rate was significantly different between the two groups (18.8% vs 27.3%, P < 0.05), but the length of ICU stay had no significant difference [(15.5±3.4) days vs (16.6±5.2) days]. The respiratory rate, pulse rate, SaO2 and PaO2/FiO2 at 6 h after extubation in the HFNC group were improved markedly than those in the COT group (P < 0.05);and the PaCO2 and PaO2/FiO2 at 24 and 72 h after extubation in the HFNC group had much more improvement than those in the COT group (P < 0.05). Conclusions Among individuals with post-operative high cervical spinal cord injury, high-flow oxygen therapy could reduce re-intubation rate, and PaCO2 level, and improve the respiratory function, but cannot reduce the length of ICU stay. High-flow oxygen therapy may offer advantages for patients with high cervical spinal cord injury.