摘要
目的探讨脱机后高流量氧疗对机械通气重症患者成功拔管的价值。方法采用回顾性研究方法,选择2018年1月至2020年6月浙江医院重症医学科因脑血管意外、外科手术、心血管疾病、肺炎初次行气管插管机械通气后已脱机且年龄>18岁的患者,其中脱机后高流量氧疗40例,文丘里联合加热湿化器氧疗37例。收集患者性别、年龄、基础疾病、病情严重程度评分及脱机前机械通气时间,脱机后0、6、12、18、24 h心率(HR)、血压、脉搏血氧饱和度(SpO_(2)),脱机后6、12、18、24 h动脉血pH值、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2)),以及脱机后再上机率、脱机后拔管时间和拔管后72 h再插管率。结果两组患者性别、年龄、基础疾病、病情严重程度评分及脱机前机械通气时间等一般资料比较差异均无统计学意义。脱机后两组患者生命体征稳定,且各时间点HR、收缩压(SBP)、舒张压(DBP)、SpO_(2)比较差异均无统计学意义。脱机后两组患者动脉血气分析指标pH值及高流量组PaO_(2)、PaCO_(2)波动均不明显;文丘里组PaO_(2)在脱机后逐渐下降,PaCO_(2)在12 h前较脱机前明显升高,12 h后缓慢下降。高流量组PaO_(2)从6 h起、PaCO_(2)从12 h起均显著低于文丘里组,并持续至24 h〔PaO_(2)(mmHg,1 mmHg≈0.133 kPa):6 h为112.34±38.25比156.76±68.44,12 h为110.92±38.66比150.64±59.07,18 h为111.12±36.77比141.30±39.05,24 h为110.82±39.37比139.65±41.50;PaCO_(2)(mmHg):12 h为41.30±7.51比47.42±7.54,18 h为40.97±6.98比45.83±8.63,24 h为40.10±7.06比46.14±9.15,均P<0.01〕。高流量组脱机后再上机率和拔管后72 h再插管率显著低于文丘里组〔17.5%(7/40)比40.5%(15/37),6.2%(2/32)比31.8%(7/22),均P<0.05〕,且脱机后拔管时间较文丘里组明显缩短(h:22.43±11.72比28.07±10.42,P<0.05)。结论将高流量氧疗应用于机械通气重症患者的拔管过程中,可以减少二氧化碳潴留的发生,降低脱�
Objective To investigate the value of high-flow oxygen therapy after weaning in successful extubation of critically ill patients with mechanical ventilation.Methods A retrospective study was conducted.The weaned patients who were older than 18 years old and underwent mechanical ventilation for the first time due to cerebrovascular accidents,surgical operations,cardiovascular diseases,and pneumonia admitted to the department of critical care medicine of Zhejiang Hospital from January 2018 to June 2020 were enrolled.Among the patients,40 cases received high-flow oxygen therapy after weaning,and 37 cases received Venturi combined with the humidifier.The patient's gender,age,primary disease,severity score,duration of mechanical ventilation before weaning,heart rate(HR),blood pressure,pulse oxygen saturation(SpO_(2))at 0,6,12,18,and 24 hours after weaning,and pH value,arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))at 6,12,18,and 24 hours after weaning,the rate of performing mechanical ventilation after weaning,extubation time after weaning,and the rate of reintubation after extubation for 72 hours were collected.Results There was no significant difference in baseline data such as gender,age,primary disease,severity score,and duration of mechanical ventilation before weaning between the two groups.After weaning,the vital signs of the two groups were stable,and there was no significant difference in HR,systolic blood pressure(SBP),diastolic blood pressure(DBP)or SpO_(2)at each time point between the two groups.After weaning,the pH of arterial blood gas analysis in the two groups and the fluctuations of PaO_(2)and PaCO_(2)in the high-flow group were not obvious.In the Venturi group,PaO_(2)gradually decreased after weaning,PaCO_(2)increased significantly at 12 hours,and slowly decreased after 12 hours.The PaO_(2)from 6 hours and PaCO_(2)from 12 hours in the high-flow group were significantly lower than those in the Venturi group,and continued to 24 hours[PaO_(2)(mmHg,1 mm
作者
孙伟清
任奇
吴亮
吴浓
蔡国龙
Sun Weiqing;Ren Qi;Wu Liang;Wu Nong;Cai Guolong(Department of Critical Care Medicine,Zhejiang Hospital,Hangzhou 310030,Zhejiang,China)
出处
《中华危重病急救医学》
CAS
CSCD
北大核心
2022年第11期1144-1147,共4页
Chinese Critical Care Medicine
基金
浙江省医药卫生重大科技计划项目(WKJ-ZJ-2001)。
关键词
高流量氧疗
脱机
文丘里
High-flow oxygen therapy
Weaning
Venturi
