肺移植患者拔管后经鼻高流量氧疗的效果评价

Effects of high flow nasal cannula oxygenation therapy on the lung transplant patients after extubation

目的探讨肺移植患者拔管后经鼻高流量氧疗的效果及安全性。方法回顾性分析2017年1—12月无锡市人民医院收住的60例术后拔除气管插管的肺移植患者,根据拔管后医嘱开立的呼吸支持方式不同,分为试验组(28例,经鼻高流量氧疗)和对照组(32例,鼻导管吸氧)。对比两组患者的血气分析(氧合指数、乳酸、二氧化碳分压)、痰液黏稠度和舒适度等临床指标。结果拔管后6 h和转科前试验组的氧合指数分别为(263.70±48.97)、(273.22±43.26)mmHg,与对照组的(217.83±77.30)、(229.08±68.64)mmHg比较,差异有统计学意义(P<0.05);转科前试验组的二氧化碳分压为(37.04±8.56)mmHg,较对照组的(42.43±6.14)mmHg有所下降,差异有统计学意义(P<0.05)。转科前试验组痰液黏稠度较对照组降低(P<0.05);试验组患者舒适度得分为(7.72±1.06)分,高于对照组的(4.39±0.82)分,差异有统计学意义(P<0.05)。结论经鼻高流量氧疗应用在肺移植患者拔管后疗效确切且安全可靠,可在临床中推广应用。

Objective To investigate the effect and safety of high-flow nasal cannula (HFNC) oxygen therapy for patients after extubation in lung transplantation. Methods A retrospective study was conducted on 60 hospitalized patients with lung transplant during January 2017 to December 2017 in Wuxi People's Hospital. According to the different methods of respiratory support prescribed after extubation, the patients were divided into two groups: observation group (n=28, via HFNC) and control group (n=32, via nasal oxygen tube). The two groups were compared in terms of the clinical indicators including their blood gas analysis (oxygenation index, lactic acid, partial pressure of carbon dioxide), viscosity of sputum and comfort, etc. Results Six hours after extubation and before transferring to other departments, the observation group's oxygenation index was (263.70±48.97) and (273.22±43.26) mmHg, which were statistically different from those of the control group with (217.83±77.30) and (229.08±68.64) mmHg respectively (P<0.05). Before transferring to other departments, the partial pressure of carbon dioxide in the observation group was (37.04±8.56) mmHg, lower than the control group with (42.43±6.14) mmHg with a statistical difference (P<0.05);the viscosity of sputum in the obseration group was lower than the control group with statistical difference (P<0.05);the patients' comfort in the observation group achieved (7.72±1.06) points, higher than the control group's (4.39±0.82) points with statistical difference (P<0.05). Conclusions HFNC oxygen therapy for the patients after extubation in lung transplantation has good effects, is safe and reliable, and can be widely applied in clinical practice.