经鼻高流量湿化氧疗系统在开胸术后急性低氧性呼吸衰竭患者中的应用及研究

Effects of high-flow nasal cannula for acute hypoxaemic respiratory failure patients after thoracotomy

目的:探讨经鼻高流量湿化氧疗系统(high-flow nasal cannula,HFNC)应用于开胸术后急性低氧性呼吸衰竭(acute hypoxaemic respiratory failure,AHRF)患者的疗效。方法:回顾性分2016年1月1日至2017年12月31日在陆军军医大学第一附属医院行开胸手术,转出重症监护室(intensive care unit,ICU)后出现AHRF的53例患者,常规氧疗组(31例)和HFNC组(22例)。分别于氧疗前,氧疗后2、12、48 h记录脉搏血氧饱和度(percutaneous oxygen saturation,SpO2)、心率(heart rate,HR)和呼吸频率(respiratory rate,RR)改善程度,以及咽痛/鼻痛发生率、再次气管插管率、住院时间、住院死亡率、气道痰液引流量等指标。结果:经常规和HFNC氧疗后,HFNC组患者的SpO2在治疗后2 h的值为(94.0±2.5)%、12 h的值为(95.9±1.3)%、48 h的值为(97.0±2.4)%,明显高于常规组相同时间点的(90.2±2.3)%(t=5.660,P=0.000)、(92.3±1.9)%(t=7.422,P=0.000)、(93.5±3.5)%(t=4.070,P=0.000);痰液引流量(38.4±5.7)明显高于常规氧疗组(32.1±5.5)(t=4.052,P=0.000);HFNC组RR值在2 h为(26.0±4.5)、12 h为(22.7±3.5)、48 h为(19.6±2.7),分别高于规组相同时间点的(28.6±4.5)(t=-2.152,P=0.036)、(26.5±4.1)(t=-3.537,P=0.001)、(23.0±2.9)(t=-4.932,P=0.000);再次气管插管率(χ2=5.808,P=0.025)明显减低;鼻/咽喉痛明显低于常规氧疗组(χ2=4.890,P=0.036)。结论:HFNC对AHRF疗效较常规氧疗好,可以明显改善开胸术后AHRF患者的氧合,增加痰液引流,降低再次插管率;患者临床症状改善明显,耐受性良好,可在严密监测下的普通病房开展。

Objective:To investigate the therapeutic effect of high-flow nasal cannula(HFNC)oxygen therapy after thoracotomy in patients with acute hypoxaemic respiratory failure(AHRF).Methods:A total of 53 patients who received thoracotomy in our hospital from January 1,2016 to December 31,2017 and had AHRF after discharging from ICU were retrospectively analyzed and divided into the general oxygen therapy group(n=31)and HFNC group(n=22).Saturation of peripheral oxygen(SpO2),heart rate(HR)and respiration rate(RR)both before and after treatment were recorded at 2,12,48 h;indicators such as pharyngalgia/rhinodynia incidence,re-intubation rate,hospitalization time,in-hospital mortality and sputum drainage amount were also recorded.Results:When compared with the general group,post-therapy SpO2 and sputum drainage amount in HFNC group was significantly improved;heart rate,respiratory rate,reintubation rate and pharyngalgia/rhinodynia incidence were significantly decreased in HFNC group(P<0.05).Conclusion:For treating AHRF,HFNC has a better therapeutic effect than the general oxygen therapy,which can significantly improve the oxygenation in AHRF patients after thoracotomy,increase sputum drainage amount and reduce re-intubation rate;after HFNC,patients’clinical symptoms are significantly improve and patients have a good tolerance.Therefore,HFNC deserves application in the general ward.