经鼻导管高流量吸氧对危重症患者拔除气管导管后影响研究

Effect of transnasal high-flow oxygen on the removal of tracheal tube in critically ill patients

目的探讨危重症患者拔除气管导管、脱机后,给予经鼻导管高流量吸氧治疗的临床效果。方法选取自2017年3月至2019年3月北部战区总医院呼吸与危重症医学科收治的经口或经鼻气管插管接呼吸机辅助呼吸且均按照正常程序脱机拔管的86例I型呼吸衰竭患者为研究对象。采用随机数字表法将患者分为常规组(n=43)与观察组(n=43),常规组给予普通鼻导管/文丘里面罩吸氧,观察组给予经鼻导管加温湿化高流量吸氧。观察并比较两组患者治疗2、24 h的心率、呼吸频率、氧合指数、动脉血气二氧化碳分压;评估并比较两组患者耐受性、气道湿化程度、再插管率及ICU停留时间。结果治疗后2、24 h,观察组患者心率、呼吸频率、动脉血二氧化碳分压均低于常规组,氧合指数高于常规组,差异有统计学意义(P<0.05)。观察组患者耐受性评分、气道湿化满意率明显优于常规组,再插管率、ICU停留时间低于常规组,差异有统计学意义(P<0.05)。结论危重症患者拔除气管导管后应用经鼻导管高流量吸氧可提高氧合指数,改善患者耐受性,加强气道湿化,降低再插管率,缩短ICU停留时间。

Objective To investigate the clinical effect of nasal hyperbaric oxygen therapy in critically ill patients after removal of tracheal tube and weaning.Methods A retrospective study was performed on 86 cases of patients with Type I respiratory failure who were admitted in Respiratory and Critical Care Medicine from March 2017 to March 2019.The patients were randomly divided into the conventional group(n=43)and the observation group(n=43).The conventional group of patients were given the ordinary nasal catheter/venturi mask oxygen,while the observation group of patients were given the transnasal catheter with temperature humidification and high-flow oxygen.The heart rate,respiratory rate,oxygenation index and arterial blood gas carbon dioxide partial pressure of the two groups of patients at 2 and 24 hours after treatment were observed and compared.Tolerance,airway humidification,re-intubation rate and ICU stay were evaluated and compared between the two groups.Results At 2 and 24 hours after treatment,the heart rate,respiratory rate and partial pressure of arterial blood carbon dioxide in the observation group were all lower than that in the conventional group,and the oxygenation index was higher than that in the conventional group,with statistically significant differences(P<0.05).The tolerance score and satisfaction rate of airway humidification in the observation group were significantly better than those in the conventional group,while the re-intubation rate and ICU stay were lower than those in the conventional group(P<0.05).Conclusion The application of transnasal high-flow oxygen after tracheal catheter removal in critically ill patients can improve oxygenation index,improve patient tolerance,strengthen airway humidification,reduce reintubation rate and shorten ICU stay.