高流量鼻导管吸氧治疗心脏外科术后低氧血症的效果分析-东南大学学报医学版

高流量鼻导管吸氧治疗心脏外科术后低氧血症的效果分析

单位：1. 无锡市人民医院/南京医科大学附属无锡人民医院心脏外科, 江苏无锡 214023;
2. 无锡市人民医院/南京医科大学附属无锡人民医院胸科重症医学科, 江苏无锡 214023

分类号：R619;R654

出版年·卷·期（页码）：2019·38·第四期（718-721）

摘要：

目的：了解经鼻高流量吸氧方法在心脏手术患者脱离呼吸机后应用的适应证及优劣。方法：对2015年1月至2018年10月行心脏手术后拔除经口插管而呼吸困难患者，应用无创呼吸机辅助42例（NPPV组），采取经鼻高流量吸氧55例（HFNCO组）。收集两组基本资料，包括治疗前、治疗后2、8、24h的心率、动脉血pH、氧分压（PaO₂）、二氧化碳分压（PaCO₂）、氧合指数（PaO₂/FiO₂）、呼吸次数（RR），ICU滞留时间，住院时间，胃肠胀气，耐受情况及院内死亡率等数据，对两组数据进行比较。结果：应用呼吸辅助后，随着时间的延长HFNCO组心率下降较明显，PaCO₂、PaO₂/FiO₂、RR、胃肠胀气及耐受程度等指标均较NPPV组有明显好转（均P<0.05）；但在pH、PaO₂、院内死亡率等指标方面两组差异无统计学意义（均P>0.05）。结论：对于心脏手术后脱离呼吸机患者，经鼻导管的高流量吸氧技术具有耐受性良好、胃肠胀气少的优势，其改善通气及氧合指数、减少呼吸肌做功、提供呼吸末正压的功能不劣于传统的经面罩无创呼吸机。

Objective: To study the effect of high-flow nasal catheter oxygenation applied in extubation patients after adult cardiac surgeries. Methods: From Jan. 2015 to Oct. 2018, 42 patients were treated with non-invasive positive pressure ventilation when dyspnea occurred after airway extubation(NPPV group), 55 patients with same complains were treated with high-flow nasal catheter oxygenation randomly (HFNCO group). The collected data included basic information of these patients, the preoperative and 2, 8, 24 hours postoperative information of heart rates, pH, PaO₂, PaCO₂, PaO₂/PaCO₂ and respiratory rates. The ICU stay and hospital stay, tolerance, flatulence were also recorded. Results: Compare to the NPPV group, heart rates, PaCO₂,PaO₂/FiO₂, respiratory rates, flatulence and tolerance were better in the HFNCO group(P<0.05), The significance between pH, PaO₂, mortality was samiliar(P>0.05). Conclusion: For the airway extubation patients of hypoxemia after cardiac surgery, HFNCO provides a score with better tolerance and less flatulence, not inferior to that of traditional NPPV with a mask in terms of a better ventilation, oxygenation and positive end expiratory pressure, reduces respiratory muscle work.

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