摘要
目的比较高流量湿化氧疗(HFHO)脱机方案和T管脱机方案对脱机困难患者的脱机效果和呼吸机相关肺炎(VAP)发生率等方面的影响,以期寻找更合理的脱机方案。方法本研究为队列研究,非随机选取2015年1月至2021年8月中国人民解放军第八医学中心重症医学科收治的、机械通气≥24 h且经脱机筛查符合脱机困难标准的164例脱机困难患者,分为HFHO组80例和T管组84例。比较2组患者的一般资料、脱机成功率、7 d内二次插管率、痰液黏稠度、湿化良好率和VAP感染率等。结果脱机前HFHO组动脉血氧分压(PaO2)和氧合指数均低于T管组,分别为104(86.00,137.50)mmHg比125(99.00,155.80)mmHg、(311.9±39.4)比(355.6±129.5)(Z=2.54,t=2.41,均P<0.05)。HFHO组总脱机成功率与T管组差异无统计学意义,73.75%(59/80)比59.52%(50/84),χ^(2)=3.72,P=0.054。94例气管插管的患者中选择HFHO脱机的40例,选择T管脱机的54例,再次分析2种脱机的成功率,结果显示气管插管患者应用HFHO脱机成功率高于T管组,92.50%(37/40)比59.26%(32/54),(χ^(2)=13.01,P<0.01)。气管插管患者中HFHO脱机的患者7 d内二次插管率低于T管脱机的患者8.10%(3/37)比28.13%(9/32),(χ^(2)=4.79,P<0.05)。HFHO组痰液黏稠度(Ⅰ度、Ⅱ度、Ⅲ度)及气道湿化效果良好率HFHO组均优于T管组(P<0.05),分别为26.25%(21/80)、53.75%(43/80)、20.00%(16/80)比11.90%(10/84)、60.71%(51/84)、27.38%(23/84);63.75%(51/80)比40.48%(34/84)。2组VAP感染率差异无统计学意义(P>0.05)。结论HFHO脱机模式更适合于临床脱机困难患者。
Objective To compare the effects of high-flow humidified oxygen therapy(HFHO)and T-tube weaning on weaning effect and the infection rate of ventilator-associated pneumonia(VAP)in patients with difficult weaning,so as to find a more reasonable weaning scheme.Methods This was a cohort study.From January 2015 to August 2021,a total of 164 patients with difficult weaning who met the selection criteria admitted to the Department of Critical Care Medicine,8th Medical Center of Chinese PLA General Hospital,with mechanical ventilation≥24h,and who met the inclusion criteria of difficult weaning were selected non randomly,and they were divided into HFHO group(80 cases)and T-tube group(84 cases).The demographic data of the patients in the two groups,the success rate of weaning,the re-intubation rate within 7 days,the infection rate of VAP,and the airway humidification effect were all compared.Results Before weaning,PaO2 and oxygenation index of HFHO group were lower than those of T-tube group,which were 104(86.00,137.50)mmHg vs 125(99.00,155.80)mmHg,(311.9±39.4)vs(355.6±129.5)respectively(Z=2.54,t=2.41,P<0.05).There was no significant difference in the weaning success rate between HFHO group and T-tube group,with 73.75%(59/80)vs 59.52%(50/84)(χ^(2)=3.72,P=0.054).Among 94 patients with tracheal intubation,40 patients chose HFHO weaning and 54 patients chose T-tube weaning,and the success rate of two weaning modes was analyzed again.The weaning success rate of tracheal intubation patients in the HFHO group was significantly higher than that of the T-tube group,92.50%(37/40)vs 59.26%(32/54),(χ^(2)=13.01,P<0.01).The secondary intubation rate within 7 days of tracheal intubation patients in the HFHO group was lower than that of the T-tube group,8.10%(3/37)vs 28.13%(9/32),(χ^(2)=4.79,P<0.05).Sputum viscosity(Ⅰ,Ⅱ,Ⅲ)in HFHO group was better than that in T-tube group,which were 26.25%(21/80),53.75%(43/80),and 20.00%(16/80)vs 11.90%(10/84),60.71%(51/84),and 27.38%(23/84);good rate of airway humidification in HFHO group w
作者
王晓丹
张玉想
王佳兴
王娇
宣律
江利亚
徐成
王蓓蕾
Wang Xiaodan;Zhang Yuxiang;Wang Jiaxing;Wang Jiao;Xuan Lu;Jiang Liya;Xu Cheng;Wang Beilei(Department of Critical Care Medicine,Beijing Geriatric Hospital,Beijing 100095,China;Department of Critical Care Medicine,8th Medical Center,Chinese PLA General Hospital,Beijing 100091,China)
出处
《国际呼吸杂志》
2023年第1期81-86,共6页
International Journal of Respiration
基金
首都临床特色应用研究项目(Z181100001718026)。
关键词
脱机困难
高流量湿化氧疗
脱机模式
Difficult weaning
High-flow humidified oxygen therapy
Weaning mode
