机械通气撤离过程中经鼻高流量氧疗降低再插管率的疗效研究

郑艳杰; 宋玲莉; 王大伟

doi:10.13201/j.issn.1009-5918.2021.08.007

机械通气撤离过程中经鼻高流量氧疗降低再插管率的疗效研究

- 1. 山东大学附属威海市立医院急诊科(山东威海, 264200);
- 2. 武汉大学中南医院重症医学科
基金项目:
武汉大学中南医院科技创新培育基金(No:znpy2019059)

详细信息

通讯作者: 王大伟,E-mail:hanyupiaoxiang@126.com

中图分类号: R459.7

收稿日期: 2021-03-27

Effect of high-flow nasal cannula therapy on reducing reintubation rate during mechanical ventilate-off-line extubation

- 1. Department of Emergency, Weihai Mucipal Hospital, Cheeloo College of Medicine, Shandong University, Weihai, Shandong, 264200, China;
- 2. Department of critical Medicine, Central South Hospital of Wuhan University

More Information

Corresponding author: WANG Dawei, E-mail: hanyupiaoxiang@126.com

Received Date: 27 March 2021

摘要

摘要: 目的:评估加温加湿高流量氧疗在重症患者脱机-拔管过程中的应用价值。方法:选取经口气管插管机械通气拟脱机且神志清楚的187例危重患者(呼吸系统65例,神经系统39例,消化系统22例,循环系统18例,泌尿系统25例,妇产科18例)。前瞻性分为4组,A组(49例):脱机后,给予加温加湿高流量氧疗后再行气管拔管;B组(43例):拔管后,给予加温加湿高流量氧疗;C组(48例):脱机后,给予鼻导管氧疗后再行气管拔管;D组(47例):拔管后,给予鼻导管氧疗。观察比较各组患者在拔管脱机治疗72 h后舒适度和再插管率。舒适度采用视觉模拟评分(VAS)法。分别在A组与C组、B组与D组之间进行比较。结果:(1)A、B、C、D组的APACHEⅡ评分分别为:28.96±2.97、28.29±2.83、29.37±3.15、28.11±3.03,差异无统计学意义(P>0.05);(2)舒适度:4组舒适度由高到低排序为B、D、A、C组,与A组比,B组的舒适度明显最高,C组舒适度最低,差异有统计学意义(P<0.05);与B组比,D组的舒适度略低,差异有统计学意义(P<0.05);加温加湿高流量氧疗组高于经鼻导管吸氧疗组:在先氧疗再拔管过程中,高出0.91~1.17分、在先拔管再氧疗中,高出1.59~2.17分。队列比较:加温加湿高流量氧疗时,先拔管的舒适度高于先氧疗2.30~3.02分,经鼻导管氧疗时,先拔管的舒适度高于先氧疗1.63~2.47分。(3)再插管率:A组(6.5%)与B组(4.9%)(P=0.756)、C组(26.3%)与D组(27.0%)(P=0.958)之间比较,差异无统计学意义。A组、B组均低于C组(P=0.033)与D组(P=0.020),说明不论先拔管还是先脱机,加温加湿高流量氧疗优于经鼻氧疗法。结论:在脱机-拔管-氧疗序贯治疗过程中,(1)脱机后,加温加湿高流量氧疗患者的舒适度优于经鼻导管氧疗。(2)先拔管舒适度优于先脱机氧疗流程。(3)先拔管+加温加湿高流量氧疗在机械通气-脱机-拔管-氧疗序贯治疗中,舒适度和72 h再插管率上是最好的方案,值得临床推广应用。
- 加温加湿高流量氧疗 /
- 气管插管 /
- 机械通气
Abstract: Objective: To evaluate the value of high-flow nasal cannula(HFNC) therapy during off-line extubation in severe patients.Methods: To observe the comfort level and the effect on the rate of reintubation after 72 h of weaning treatment, the patients who are critically conscious after incubation were selected and divided into four observation groups according to the application time of high-flow nasal cannula therapy and nasal catheter oxygen therapy. Group A(49 cases), was treated with high-flow nasal cannula therapy after taking off the ventilator,subsequent with tracheal extubation. Group B(43 cases), was treated with high-flow nasal cannula therapy after tracheal extubation. Group C(48 cases) being taken off the ventilator was treated with nasal catheter before tracheal extubation. Group D(47 cases) was treated with nasal catheter after tracheal extubation. When the off-line program began, the visual analogue scale(VAS) were applied to evaluate the degree of the comfort level. Comparisons were respectively made between groups A and C, and B and D. In the meantime, the rate of reintubation within 72 hours were evaluated.Results:(1)The APACHE Ⅱ scores of the 4 groups(group A, B, C, and D) were: 28.96±2.97, 28.29±2.83, 29.37±3.15, and 28.11±3.03, with no statistical differences between them.(2)Comparison of comfort level: the comfort level of the four groups was ranked as B, D, A and C from high to low.(compared with group A, the group B was higher and the difference was statistically significant. compared with the group B, the group D was slightly lower and the difference was statistically significant.) The comfort level of patients with high-flow nasal cannula therapy was higher than the patients with transnasal catheter oxygen treatment(0.91-1.17 points higher in the process of prior oxygen treatment and extubation; 1.59-2.17 points higher in the process of prior extubation and oxygen treatment). During the therapy of high-flow nasal cannula treatment, the comfort level was higher(extubation 2.30-3.02 points higher than preoxygenation); during the therapy of transnasal catheter oxygen treatment(extubation 1.63-2.47 points higher than preoxygenation).(3)Comparison of reintubation rate: there were no differences between groups A and B, and C and D. However, the rate of reintubation of these with high-flow nasal cannula therapy was lower than those with transnasal catheter oxygen therapy.Conclusion: During the sequential treatment of off-line and extubation:(1)The comfort of patients with high-flow nasal cannula therapy was better than that with transnasal catheter oxygen therapy after off-line.(2)The comfort of patients with the first drawing tube therapy was better than that with the first oxygen therapy.(3)In the sequential treatment of mechanical ventilate-off-line-extubation-oxygen therapy, extubation+high-flow nasal cannula therapy was the best scheme in terms of comfort and 72 h re-intubation rate, which was worthy of clinical promotion.
- high-flow nasal cannula /
- intubation /
- mechanical ventilation

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