摘要:
目的 比较ICU内使用经鼻高流量氧疗与无创通气治疗在腹部外科术后患者脱离呼吸机拔管后并发轻中度急性低氧性呼吸衰竭的临床疗效.方法 选择住昆明医科大学附属甘美医院ICU的48例腹部外科术后脱机后并发急性轻中度低氧性呼吸衰竭患者, 按数字法将患者随机分为经鼻高流量氧疗组 (HFNV) 和无创通气组 (NIV) , 均为24例, 比较2组患者脱机前 (T0) 及脱机后30 min (T1/2) 及24 h (T24) 患者的平均动脉压MABP;相应时段的呼吸指标:呼吸频率 (R) ;氧合指数 (PaO2/FiO2) , 动脉血二氧化碳分压 (PaCO2) 变化;2组治疗期间患者不耐受指定氧疗方法而互相转化治疗的病例数以及病情恶化再次插管行有创机械通气治疗的患者数;观察期结束运用数字评分0分至10分让患者主观评价对随机指定氧疗时呼吸困难感及舒适程度打分, 分值越高主观评价治疗效果越好;记录2组设备相关性良性副面损伤的发生率;ICU住院时间及病死率.通过对比客观及主观感受指标, 评估运用该新型氧疗方法疗效.结果 2组患者基本人口学特征参数年龄、性别构成、APACHEII评分、SOFA评分、基本病因及既往病史、入选研究后拔管前呼吸机治疗时间差异无统计学意义 (P>0.05) ;客观指标T1/2、T24时呼吸指标NIV组PaO2/FiO2更高[ (242±36.5) mm Hg、 (267±48.9) mm Hg], HFNV组[ (195±23.4) mm Hg、 (224±62.7) mm Hg], P<0.05) ;T0、T1/2、T24血流动力动力学指标及其它呼吸指标差异无统计学意义 (P>0.05) ;主观数字评分指标HFNV组 (5.7±2.8) 优于NIV组 (2.8±1.5) , P<0.05;设备相关良性副反应NIV组更加突出 (14例, 58.3%) , HFNV组 (4例, 16.7%) , P<0.01) ;NIV组转HFNV组3例, 占12.5%;无HFNV组转NIV组, P<0.05;2组均无病例再次气管插管呼吸机治疗;HFNC组有1例患者因急性心肌梗塞猝死, 2组住ICU时间及病死率差异无统计学意义.结论 腹部外科术后患者早期脱呼吸机拔管后并发轻中度急性低氧性呼吸衰竭, 采用有NIV治疗较HFNC治疗改善低氧血症疗效好, 但HFNC从患者呼吸困难感受及舒适性和其他呼吸及血流动力学和预后综合指标评比优于NIV, 更易被患者接受.
Abstract:
Objective To compare the clinical effects between nasal high flow oxygen therapy and non-invasive ventilation care for post-extubation mild-to-moderrate hypoxemia after abdominal surgery In ICU.Methods Forty-eight patients with post-extubation hypoxemia after abdominal surgery in our ICU were randomly divided into 2 groups: high flow oxygen therapy group and non-invasive ventilation group.Patients in the two groups were treated with HFNV and NIV, respectively, for 1 day.Then we compared the data including: 1.objective respiratory and circulatory parameters (R, PaO2/FIO2, PaCO2;MABP) during at pre-extubation (T0) and post- extubation 30 minuts (T1/2) and the 24 hours (T24) as well as a subjective rating of dyspnea and discomfort by the patients on a number10-points scale of 0 (lowest) to 10 (highest) in the end of 24 h observation period;2. Devices related benign side effects (nose and mouth dryness, skin pressure redness or ulcer, nose or mouth mucosal lesions, thirsty.3. ICU stay and mortality.Results There were no significant differences in the baseline characteristics of the patients between two groups including age, sex, APACHEII score, SOFA score, major etiology and previous illnesses ratio, pre-extubation mechanic ventilation times, P>0.05) ;the PaO2/FIO2 in NIV group at T1/2, T24 were better than HFNV group (222±36.5) , (267±88.9) mm Hg versus (195±23.4) , (224±82.7) mm Hg, P<0.05;T0, T1/2, T24 the circulatory parameters and others respiratory parameters had no significant differences, P >0.05; in contrast, on getting the number10-points scale of 0 (lowest) to 10 (highest) in the final study time interview from the patients, HFNV group (5.7±2.8) was significantly better than NIV group (2.8±1.5) , P<0.05.Devices related side effects in the NIV group (14 cases, 58.3%) was more obvious than the HFNV group (4 cases, 16.7%, P<0.01) ;3 cases, 12.5% in group NIV were changed to HFNV care, in contrast, there was no case changed to the NIV treatment, P<0.05;without any cases in two groups, they were reintubated for invasive ventilation.One old male case in HFNC group died from acute myocardial infarction, but there was no significant differences in ICU stay and mortality.Conclusion Compared with the NIV, in general, the HFNC therapy may offer a better choice for post-extubation mild-to-moderrate hypoxemia after abdominal surgery in ICU.
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