高流量氧疗降低机械通气患者拔管失败率的研究

High flow oxygen therapy reduces the rate of extubation failure:a prospective clinical study

目的对比研究高流量鼻导管氧疗(high flow nasal catheter oxygen,HFNCO)技术在降低机械通气患者拔管后48 h内拔管失败率、再插管率及相关并发症的发生率的作用。方法采用前瞻性、单中心、随机对照研究方法,选取昆明医科大学第一附属医院ICU中77例机械通气治疗时间≥48 h并达到自主呼吸实验(spontaneous breathing test,SBT)条件的患者。进行30 min SBT时利用超声筛选出肺部超声评分(lung ultrasound scores,LUS)≥14的患者,在拔管后随机(随机数字法)接受不同方式的氧疗。根据氧疗方式分为传统氧疗组、无创正压通气(noninvasive ventilation,NIV)组和HFNCO组,比较三组患者拔管后氧疗效果及转归。计量资料采用均数±标准差(Mean±SD)表示;计数资料采用率(构成比)表示。正态分布计量资料两组间采用两独立样本t检验,多组间比较采用完全随机设计资料的方差分析,两两比较采用LSD-t检验,计数资料比较采用χ2检验,以P<0.05为差异有统计学意义。结果两组患者性别,年龄等一般情况比较差异无统计学意义(P>0.05)。NIV组和HFNCO组患者拔管后48 h内拔管失败率(14.29%,15.38%vs 34.87%)、再插管率(10.7%,11.54%vs 21.74%)较传统氧疗组低;传统氧疗组患者的机械通气时间[(24.33±4.42)d vs(8.58±1.09)d(,8.37±2.43)d],抗生素使用时间[(19.21±4.37)d vs(8.34±2.54)d(,7.41±1.06)d]和ICU入住时间([27.27±4.24)d vs(10.38±2.07)d(,9.44±0.79)d]均较其他两组患者延长(P<0.05)。结论拔管后使用HFNCO或NIV治疗均能有效降低拔管失败率及再插管率,减少机械通气时间、ICU入住时间和抗生素使用时间。两者之间的临床效率无差别。但由于HFNCO与NIV相比,能有效降低呼吸频率,避免CO2的蓄积,在临床上有更大的应用前景。

Objective To evaluate the effect of high flow nasal catheter oxygen(HFNCO)therapy on extubation failure rate,reintubation rate,and incidence of related complications within 48 h after extubation in mechanically ventilation patients.Methods A prospective,single-center,randomized controlled trial was conducted in the ICU of a teaching hospital affiliated to a medical university.A total of 77 patients with mechanical ventilation duration of≥48 h and met the condition of spontaneous breathing test(SBT)were selected.The patients whose LUS≥14 at 30 min of SBT were enrolled,and were randomly(random number)divided into 3 groups according to different oxygen therapies:the traditional oxygen therapy group,the noninvasive ventilation(NIV)group,and the HFNCO group.The effect of oxygen therapy and outcomes after extubation were compared among the three groups.The measurement data were presented as the mean±standard deviation(SD),and the numeration data were expressed as ratio or constituent ratio.The independent sample t test and LSD-t test were used for the comparisons between the two groups and the one-way ANOVA for differences between multiple groups.The differences between enumeration data were assessed by chi-square test.A P<0.05 was considered statistically significant.Results There was no significant difference in gender,age and other general conditions between the two groups(P>0.05).The NIV group and HFNCO group had lower extubation failure rate(14.29%,15.38%vs 34.87%)and reintubation rate(10.7%,11.54%vs 21.74%)than the conventional oxygen therapy group(P<0.05).In addition,the traditional oxygen therapy group had longer mechanical ventilation duration[(24.33±4.42)d vs(8.58±1.09)d,(8.37±2.43)d],antibiotic use time[(19.21±4.37)d vs(8.34±2.54)d,(7.41±1.06)d],and ICU hospitalization time[(27.27±4.24)d vs(10.38±2.07)d,(9.44±0.79)d],all P<0.05.Conclusions Treatment with HFNCO or NIV after extubation can effectively reduce the rates of extubation failure and reintubation,and improve the outcome of the mechanical ventilation.There is no difference in clinical efficiency between the NIV group and HFNCO group.However,compared with NIV,HFNCO can effectively reduce respiratory rate and avoid the retention of CO2,which has a wider application prospect in clinical practice.