摘要
目的观察经鼻高流量氧疗(HFNC)联合膈肌电活动(EAdi)监测对慢性阻塞性肺疾病(COPD)患者拔管后氧疗的效果。方法选择2019年1月至2020年6月衢州市人民医院重症监护病房(ICU)收治的36例行拔管后氧疗的COPD患者,将患者按随机数字表法分为观察组和对照组,每组各18例。观察组患者拔管后立即给予HFNC;对照组患者拔管后给予湿化瓶连接普通文丘里面罩吸氧。观察两组患者拔管后30 min、1 h、8 h、24 h的心率(HR)、呼吸频率(RR)、血气分析指标及EAdi值变化。结果共纳入36例患者,其中32例成功撤机,4例在拔管后48 h内再次插管。①两组患者拔管后30 min HR、RR及氧合指数(PaO_(2)/FiO_(2))和动脉血二氧化碳分压(PaCO_(2))数值相当;随时间延长,两组患者HR、RR和PaO_(2)/FiO_(2)均呈逐渐升高趋势,但观察组HR、RR升高幅度更小,拔管后24 h时明显低于对照组〔HR(次/min):81.44±7.90比92.28±13.92,RR(次/min):18.67±2.57比23.39±5.59,均P<0.05〕,观察组PaO_(2)/FiO_(2)升高幅度更大,拔管后24 h时明显高于对照组〔mmHg(1 mmHg≈0.133 kPa):316.94±44.92比278.44±49.35,P<0.05〕;观察组PaCO_(2)持续升高至拔管后8 h随后降低,对照组PaCO_(2)持续升高,观察组各时间点PaCO_(2)均明显低于对照组,以24 h最为明显(mmHg:39.78±5.65比47.17±7.25,P<0.05)。②随时间延长,两组患者的EAdi_(max)和EAdiAUC均呈升高趋势,但观察组升高幅度更小,拔管后24 h时明显低于对照组,差异均有统计学意义(EAdi_(max):14.33±5.49比21.29±5.17,EAdiAUC:10.72±3.55比15.02±4.03,均P<0.05)。③观察组患者ICU住院时间较对照组明显缩短(d:6.17±1.54比9.39±3.87,P<0.05),48 h内再次插管率虽低于对照组但差异无统计学意义〔5.6%(1/18)比16.7%(3/18),P>0.05〕。结论HFNC可提高COPD患者拔管后的PaO_(2)/FiO_(2),降低RR,改善二氧化碳(CO_(2))潴留,缩短ICU住院时间。
Objective To observe the efficiency of transnasal high flow oxygen therapy(HFNC)combined with diaphragmatic electrical activity(EAdi)monitoring for chronic obstructive pulmonary diseases(COPD)patients after extubation.Methods Thirty-six patients with the diagnostic criteria for COPD admitted to the intensive care unit(ICU)of Quzhou People's Hospital adopt oxygen therapy after tracheal extubation from January 2019 to June 2020 were selected.Patients were divided into observation group and control group by random number table method,18 cases in each group.Patients in the observation group were given HFNC immediately after extubation;while in the control group were given a humidified bottle connected to a common venturi.Observe the changes of heart rate(HR),respiratory rate(RR),blood gas analysis and EAdi values of the two groups of patients 30 minutes,1 hour,8 hours,24 hours after extubation.Results A total 36 patients were enrolled,32 cases of whom were successfully weaned and 4 cases of the offline failures within 48 hours after extubation.①HR,RR,oxygenation index(PaO_(2)/FiO_(2))and arterial blood carbon dioxide partial pressure(PaCO_(2))were similar in the two groups 30 minutes after extubation;with the extension of time,HR,RR and PaO_(2)/FiO_(2) in the two groups increased gradually,but the increase of HR and RR in the observation group was smaller,which was significantly lower than that in the control group at 24 hours after extubation[HR(times/minute):81.44±7.90 vs.92.28±13.92,RR(times/minute):18.67±2.57 vs.23.39±5.59,both P<0.05].The increase of PaO_(2)/FiO_(2) in the observation group was greater,which was significantly higher than that in the control group at 24 hours after extubation[mmHg(1 mmHg≈0.133 kPa):316.94±44.92 vs.278.44±49.35,P<0.05];PaCO_(2) in the observation group increased continuously until 8 h after extubation,and then decreased,PaCO_(2) in the control group increased continuously.PaCO_(2) in the observation group was significantly lower than that in the control group at all time
作者
陈梅琴
王丹琼
方红龙
罗建
熊晓华
张伟文
Chen Meiqin;Wang Danqiong;Fang Honglong;Luo Jian;Xiong Xiaohua;Zhang Weiwen(Department of Intensive Care Unit,the Quzhou Affiliated Hospital of Wenzhou Medical University,Quzhou People's Hospital,Quzhou 324000,Zhejiang,China)
出处
《中国中西医结合急救杂志》
CAS
CSCD
北大核心
2021年第5期527-530,共4页
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
基金
浙江省衢州市科技计划指导性项目(2018073)
浙江省医药卫生科技项目(2020KY1023)。
关键词
慢性阻塞性肺疾病
经鼻高流量氧疗
膈肌电活动
拔管
Chronic obstructive pulmonary disease
Transnasal high-flow oxygen therapy
Diaphragmatic muscle electrical activity
Extubation
