经鼻高流量氧疗在肝移植术后急性肺损伤患者中的应用

The use of high-flow nasal cannula oxygenation in adult patients with acute lung injury after liver transplantation

目的观察经鼻高流量氧疗(HFNCO)对肝移植术后急性肺损伤患者呼吸功能的影响。方法纳入2015年1月至12月天津市第一中心医院移植外科行原位肝移植的患者200例,80例不符合急性肺损伤诊断退出,共纳入120例。采用随机数字表法将入选患者分为HFNCO组和鼻导管组,各60例。记录两组拔除气管插管即刻、拔管后2 h、拔管后第1天和第2天的呼吸频率、氧合指数和PaCO2,比较再插管率、ICU停留时间。结果肝移植术后急性肺损伤发生率为60.0%(120/200)。HFNCO组无再次插管,鼻导管组中6例(10.0%)再插管,两组比较差异有统计学意义(P<0.05)。拔管后2 h、拔管后第1天、拔管后第2天,HFNCO组呼吸频率低于鼻导管组,分别为[(19.4±4.5)次/min比(21.7±5.1)次/min]、[(18.9±4.2)次/min比(22.5±4.4)次/min]、[(19.0±3.7)次/min比(23.2±4.7)次/min],差异有统计学意义(P<0.05)。HFNCO组氧合指数高于鼻导管组,分别为[(242.6±65.0)mmHg比(206.6±44.2)mmHg]、[(245.6±70.4)mmHg比(211.1±62.8)mmHg]、[(238.2±62.8)mmHg比(210.4±57.1)mmHg],差异有统计学意义(P<0.05)。两组PaCO2和ICU停留时间比较,差异均无统计学意义(P>0.05)。结论与常规鼻导管吸氧比较,HFNCO能更有效提高肝移植术后急性肺损伤患者氧合指数,降低呼吸频率,改善患者呼吸功能,降低再插管率。HFNCO是肝移植术后急性肺损伤患者更适合的氧疗方式。

Objective To study the use of high flow nasal cannula oxygenation(HFNCO)on the respiratory function of patients with acute lung injury after liver transplantation.Methods This is a randomized controlled interventional study.Among 200 adults who underwent liver transplantation from Jan 2015 to Dec 2015 in the Department of Transplant Surgery,Tianjin First Central Hospital,80 patients who did not meet the criteria for acute lung injury were excluded.Of the remaining 120 patients who were included in the study,they were divided into the HFNCO group and the nasal catheter group by the random number table method,with 60 patients in each group.The respiratory rate(RR),oxygenation index(PaO2/FiO2)and PaCO2 were recorded immediately after extubation,2 h after extubation,1st day after extubation and 2nd day after extubation.The reintubation rate and duration of ICU stay were compared.Results The incidence of acute lung injury after liver transplantation was 60.0%(120/200).There was no reintubation in the HFNCO group,and 6 patients(10.0%)in the nasal catheter group were reintubated.The difference between the two groups was statistically significant(P<0.05).The RR of the HFNCO group was lower than that of the nasal catheter group[(19.4±4.5)breaths/min vs.(21.7±5.1)breaths/min],[(18.9±4.2)breaths/min vs.(22.5±4.4)breaths/min],[(19.0±3.7)breaths/min vs.(23.2±4.7)breaths/min](all P<0.05)2 h after extubation,on the 1st and 2nd day after extubation.The oxygenation index of the HFNCO group was significantly higher than that of the nasal catheter group[(242.6±65.0)mmHg vs.(206.6±44.2)mmHg],[(245.6±70.4)mmHg vs.(211.1±62.8)mmHg],[(238.2±62.8)mmHg vs.(210.4±57.1)mmHg](all P<0.05).There was no statistically difference in the PaCO2 and the duration of ICU stay between the two groups(P>0.05).Conclusions Compared with the conventional nasal catheter oxygen inhalation,HFNCO was more effective in improving oxygenation index,reducing RR,improving respiratory function and reducing reintubation rate in patients with acute lung injury after liver transplantation.HFNCO is a more suitable oxygen therapy for patients with acute lung injury after liver transplantation.