经鼻高流量湿化氧疗在危重症患者机械通气拔管后的应用价值

Application Value of Humidified High Flow Nasal Oxygen Cannula in Critically Ill Patients after Extubation

目的探讨危重症患者拔除气管导管后应用经鼻高流量湿化氧疗的临床价值。方法收集机械通气患者126例,采用随机数字表法分为经鼻高流量湿化氧疗组(HFNC组)和非重复吸氧面罩组(NRB组)。比较两组患者拔管前和拔管后24 h的主要呼吸参数和生理指标,以及再插管率、ICU住院时间和死亡率。结果两组患者拔管前后血流动力学模式无改变。拔管后两组患者的呼吸频率均轻度增快,但差别无统计学意义(P>0.05)。拔管前,两组的氧合指数(PaO_(2)/FiO_(2))及二氧化碳分压(PaCO_(2))水平差别均无统计学意义(P>0.05);拔管后,HFNC组的PaO_(2)/FiO_(2)较NRB组明显升高(P<0.05),而PaCO_(2)水平则明显低于NRB组(P<0.05)。HFNC组的二次插管率更低(P<0.05)。两组的ICU住院时间和死亡率差别均无统计学意义(P>0.05)。结论危重症患者拔除气管导管后应用经鼻高流量湿化氧疗可有效改善氧合和通气,减少二次插管。

Objective To explore the clinical application value of humidified high-flow nasal cannula(HFNC)in critically ill patients after extubation.Methods 126 consecutive cases of ventilated critical care patients in intensive care unit(ICU)of our hospital during January 2017 to December 2019 were analyzed.The 126 patients were randomly allocated to two groups:HFNC group and NRB(non repetitive oxygen mask)group.Vital respiratory and physiological parameters were assessed prior to extubation and 24 hours after extubation.The re-intubation rate,ICU length of stay and mortality between two groups were also compared.Results The two groups demonstrated similar hemodynamic patterns before and after extubation.The respiratory rate was slightly elevated in both groups after extubation with no differences observed between groups(P>0.05).There were no statistically significant clinical differences between two groups in PaO_(2)/FiO_(2) and PaCO_(2) level before extubation(P>0.05).However,the use of HFNC resulted in improved PaO_(2)/FiO_(2) and lower PaCO_(2) level post extubation(P<0.05).There were fewer patients required reintubation(P<0.05).There were no differences in ICU length of stay and mortality(P>0.05).Conclusion High flow nasal cannula could effectively improve oxygenation,and reduce the need for re-intubation in the post-extubation period in critically ill patients in the ICU.