经鼻高流速湿化氧疗不同初始流速在ICU撤机困难患者中的应用效果

Applications of different flow rates of humidified high flow nasal cannula oxygen therapy on ICU patients with difficult weaning

目的探讨经鼻高流速湿化氧疗(HHFNC)不同初始流速对ICU撤机困难患者撤机结果和舒适度的影响,为该类患者的氧疗护理提供参考。方法本研究为随机对照试验,便利选取2019年6月至2021年6月广州市红十字会医院重症医学科收治的99例撤机困难患者,按照随机数字表法将其经鼻高流速湿化氧疗的初始流速分为40 L/min组、50 L/min组和60 L/min组,每组33例。比较3组患者撤机结果,分别于拔管前和氧疗30 min后评价3组患者口鼻腔干燥程度、咽喉疼痛程度以及生命体征和血气指标。结果3组患者ICU入住时间、住院时间、7 d二次插管率、28 d ICU病死率和住院病死率等差异无统计学意义(P>0.05);50 L/min组和60 L/min组撤机成功率分别为78.8%(24/33)和77.4%(23/31),均高于40 L/min组的53.1%(17/32),差异均有统计学意义(χ^(2)=4.78,4.09,均P<0.05)。氧疗后40 L/min组和50 L/min组以及60 L/min组的口鼻腔干燥评分、咽喉疼痛评分分别为(3.16±0.77)、(2.94±0.80)分和(3.27±0.92)、(3.09±0.77)分,以及(4.10±1.01)、(3.97±1.40)分,差异均有统计学意义(F=5.21、9.26,均P<0.05),其中50 L/min组分别与40 L/min组、60 L/min组比较,差异均有统计学意义(t值为2.62~3.99,均P<0.05)。拔管前和氧疗后3组患者生命体征和血气指标差异均无统计学意义(均P>0.05)。结论对ICU撤机困难患者拔管后实施HHFNC氧疗时,流速设置为50 L/min既可提高撤机成功率,又可以改善患者呼吸道舒适度。

Objective To explore the effects of different initial flow rates of humidified high flow nasal cannula oxygen therapy on weaning outcomes and comfort level among ICU patients with difficult weaning.Methods A total of 99 ICU patients with difficult weaning received at Guangzhou Red Cross Hospital ICU from June 2019 to June 2021 were enrolled in the present study,they were assigned to 40 L/min group,50 L/min group and 60 L/min group according to the random number table method,with 33 cases in each group.The weaning outcomes among three groups were compared,the degree of dryness of oral/nasal cavity,throat pain as well as vital signs and blood gas indexes were also compared before extubation and 30 min after the first humidified high flow nasal cannula(HHFNC)oxygen therapy.Results There was no significant difference in length of stay in ICU and hospital,re-intubation within 7 days,the mortality within 28 days in ICU and the hospital among three groups(P>0.05).The weaning success rate were 78.8%(24/33)and 77.4%(23/31)in 50 L/min group and 60 L/min,higher than in the 40 L/min group 53.1%(17/32),the difference was statistically significant(χ^(2)=4.78,4.09,both P<0.05).After oxygen therapy,the scores of dryness of oral/nasal cavity and throat pain in the 40 L/min group,50 L/min group and 60 L/min group were(3.16±0.77),(2.94±0.80)and(3.27±0.92),(3.09±0.77),and(4.10±1.01),(3.97±1.40),the differences were statistically significant(F=5.21,9.26,both P<0.05),and the differences between 50 L/min group and 40 L/min group and 60 L/min group were statistically significant(t values were 2.62-3.99,all P<0.05).However,there was no significant difference in vital signs and blood gas indexes among the three groups before extubation and after oxygen therapy(P>0.05).Conclusions Humidified high flow nasal cannula oxygen therapy for the ICU patients with difficult weaning,oxygen flow with 50L/min can not only effectively promote weaning success rate but also improve patients′respiratory comfort level.