经鼻高流量氧疗对急性呼吸衰竭患者的序贯治疗

目的探讨经鼻高流量氧疗（HFNC）用于急性呼吸衰竭患者序贯治疗的临床效果。 方法选取2016年1月至2017年12月因急性呼吸衰竭入住南通大学附属医院重症医学科行有创机械通气的患者，在撤离呼吸机拔除气管插管后仍存在低氧状态者入选本研究。随机分为对照组44例，高流量组45例。对照组给予常规氧疗方式（鼻导管、面罩），高流量组则采用经鼻高流量氧疗。比较2组患者拔除气管插管后1、8、24 h的呼吸频率、氧合指数（PaO₂/FiO₂）、动脉血氧饱和度（SaO₂）、二氧化碳分压（PaCO₂）；比较2组患者拔除气管插管后氧疗舒适度、耐受性，无创机械通气使用率，48 h再插管率的差异。 结果高流量组患者的呼吸频率低于对照组，差异具有统计学意义［1 h：（20.6±3.2）次/分 vs （24.5±3.7）次/分；8 h：（21.5±3.6）次/分 vs （20.6±3.2）次/分；24 h：（20.9±3.4）次/分 vs （24.9±4.2）次/分，均P<0.05］，PaO₂/FiO₂及SaO₂高于对照组，差异具有统计学意义［PaO₂/FiO₂：1 h：（241.5±32.6） mmHg vs （213.5±30.7）mmHg；8 h：（252.5±28.6）mmHg vs （228.1±30.7）mmHg；24 h：（261.5±32.6）mmHg vs （230.5±30.7）mmHg；SaO₂：1 h：（96.7±3.6）% vs （92.6±4.3）%；8 h：（96.3±3.8）% vs （93.2±4.3）%；24 h：（96.4±3.6）% vs （93.3±3.9）%；均P<0.05］，舒适度和耐受性优于对照组，差异具有统计学意义［（4.1±0.4）分 vs （3.1±0.4）分；（3.0±0.3）分 vs （1.4±0.3）分，均P<0.05］，无创机械通气率低于对照组，差异具有统计学意义（24.4% vs 45.4%，P<0.05），2组患者48 h再插管率比较，差异无统计学意义（11.1% vs 13.6%，P>0.05）。 结论经高流量氧疗可更好地改善急性呼吸衰竭患者气管插管拔除后的低氧状态，且有更好的舒适度和耐受性，并能降低患者无创机械通气使用率，可用于急性呼吸衰竭患者拔除气管插管后的序贯治疗。

Sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure

ObjectiveTo determine the efficacy of sequential therapy with high-flow nasal cannula oxygen in patients with acute respiratory failure. MethodsAcute respiratory failure patients admitted to department of Crititcal Care Medicine of Affiliated Hospital of Nantong University who received mechanical ventilation from January 2016 to December 2017 were enrolled in this study. After extubation, 44 patients were randomly divided into control group while 45 others in high flow oxygen group. The control group was given conventional oxygen therapy (nasal catheter or mask), and high flow group was treated with high-flow nasal cannula oxygen. Respiratory rate, PaO₂/FiO₂, SaO₂ and PaCO₂ of patients at 1h, 8h and 24h after extubation between two groups were recorded. We also recorded the comfort level and tolerance of oxygen therapy, the proportion of noninvasive ventilation and re-intubation between two groups. ResultsThe respiratory rate ( per minute) was significantly lower in the high-flow oxygen group [1 h: (20.6±3.2) times/min vs (24.5±3.7) times/min; 8 h: (21.5±3.6) times/min vs (20.6±3.2) times/min; 24 h: (20.9±3.4) times/min vs (24.9±4.2) times/min, all P<0.05] relative to control group. Compare to control therapy, PaO₂/FiO₂ and SaO₂ were significantly higher in the high-flow oxygen group [PaO₂/FiO₂: 1 h: (241.5±32.6) mmHg vs (213.5±30.7) mmHg; 8 h: (252.5±28.6) mmHg vs (228.1±30.7) mmHg; 24 h: (261.5±32.6) mmHg vs (230.5±30.7) mmHg; SaO₂:1 h: (96.7±3.6)% vs (92.6±4.3)%; 8 h: (96.3±3.8)% vs (93.2±4.3)%; 24 h: (96.4±3.6)% vs (93.3±3.9)%; all P<0.05]. Patients had better comfort and tolerance with high-flow nasal oxygen therapy compared to that in control group [(4.1±0.4) scores vs (3.1±0.4) scores; (3.0±0.3) scores vs (1.4±0.3) scores, all P<0.05]. In addition HFNC could reduce the needs for noninvasive ventilation (24.4% vs 45.4%, P<0.05). However, no significant differences were found in the re-intubation rate between two groups (11.1% vs 13.6%, P>0.05). ConclusionIn patients with acute respiratory failure after extubation, treatment with high-flow oxygen can improveoxygenationwith better comfort and tolerance. Also it can reduce the use of noninvasive mechanical ventilation in patients. The findings support the use of high-flow nasal oxygen therapy as sequential therapy after extubation in patients with acute respiratory failure.