全部 标题 作者
关键词 摘要

OALib Journal期刊
ISSN: 2333-9721
费用:99美元

查看量下载量

相关文章

更多...
-  2018 

高流量湿化氧对危重患者脱机后呼吸功能的保护作用

DOI: doi:10.7507/1671-6205.201705004

Keywords: 高流量湿化氧, 危重患者, 呼吸功能保护

Full-Text   Cite this paper   Add to My Lib

Abstract:

目的 研究高流量湿化氧治疗对重症监护病房(ICU)危重患者脱离呼吸机后的呼吸功能保护作用。 方法 将 2014 年 1 月至 2016 年 12 月期间收入我院重症医学科需呼吸机支持 48 h 以上的患者随机分为两组,患者在脱离呼吸机后分别给予高流量湿化氧治疗(HFM 组)和常规鼻导管或面罩吸氧(TO 组)治疗。其中,HFM 组共 236 例,男 116 例,女 120 例,平均年龄(55.3±21.1)岁;TO 组共 251 例,男 129 例,女 122 例,平均年龄(58.4±19.3)岁。监测患者动脉血气分析,记录动脉血氧分压、动脉血二氧化碳分压(PaCO 2)、吸入氧浓度、呼吸频率、自主呼吸时间,计算氧合指数、再次插管机械通气率、ICU 停留时间以及住院时间。 结果 两组患者氧合指数在拔管前比较,差异无统计学意义 ( P>0.05),而 HFM 组拔管后 2、4、8、24、48 h 氧合指数均明显高于 TO 组 ( P<0.05),PaCO 2 及呼吸频率方面两组间比较,差异无统计学意义( P>0.05)。HFM 组需要再次插管机械通气明显低于 TO 组(4.2% 比 10.4%, P<0.05),自主呼吸天数明显高于 TO 组[(5.4±3.2)d 比 (3.5±2.5)d, P<0.05]。尽管两组患者在总住院天数上比较,差异无统计学意义[(26.5±6.5)d 比 (27.8±5.8)d, P>0.05],而 HFM 组 ICU 滞留天数明显低于 TO 组[(10.5±6.1)d 比 (14.3±8.5)d, P<0.05]。 结论 使用高流量湿化氧治疗可以降低 ICU 危重患者脱机拔管后再次插管率,改善氧合功能,对呼吸功能有一定的保护作用

References

[1]  1. Maile R, Jones S, Pan YH, et al. Association between early airway damage-associated molecular patterns and subsequent bacterial infection in patients with inhalational and burn injury. Am J Physiol Lung Cell Mol Physiol, 2015, 308(9): L855-L860.
[2]  2. 梁娟, 胡雪慧, 孙新, 等. ICU 患者人工气道内痰痂堵管的发生率及影响因素分析. 医学临床研究, 2016, 33(11): 2095-2098.
[3]  3. Wagstaff TA, Soni N. Performance of six types of oxygen delivery devices at varying respiratory rates. Anaesthesia, 2007, 62(5): 492-503.
[4]  4. Frizzola M, Miller TI, Rodriguez ME, et al. High-flow nasal cannula: impact on oxygenation and ventilation in an acute lung injury model. Pediatr Pulmonol, 2011, 46(1): 67-74.
[5]  5. Hasani A, Chapman TH, McCool D, et al. Domiciliary humidification improves lung mucociliary clearance in patients with bronchiectasis. Chron Respir Dis, 2008, 5(2): 81-86.
[6]  6. Boles JM, Bion J, Connors A, et al. Weaning from mechanical ventilation. Eur Respir J, 2007, 29(5): 1033.
[7]  7. Sreenan C, Lemke RP, Hudson-Mason A, et al. High-flow nasal cannulae in the management of apnea of prematurity: a comparison with conventional nasal continuous positive airway pressure. Pediatrics, 2001, 107(5): 1081-1083.
[8]  8. Kubicka ZJ, Limauro J, Darnall RA. Heated, humidified high-flow nasal cannula therapy: yet another way to deliver continuous positive airway pressure?. Pediatrics, 2008, 121(1): 82-88.
[9]  9. Saslow JG, Aghai ZH, Nakhla TA, et al. Work of breathing using high-flow nasal cannula in preterm infants. J Perinatol, 2006, 26(8): 476-480.
[10]  10. Lee JH, Rehder KJ, Williford L, et al. Use of high flow nasal cannula in critically ill infants, children, and adults: a critical review of the literature. Intensive Care Med, 2013, 39(2): 247-257.
[11]  11. Nishimura M. High-flow nasal cannula oxygen therapy in adults: physiological benefits, indication, clinical benefits, and adverse effects. Respiratory Care, 2016, 61(4): 529-541.
[12]  12. Thille AW, Cortéspuch I, Esteban A. Weaning from the ventilator and extubation in ICU. Curr Opin Crit Care, 2013, 19(1): 57.
[13]  13. Thille AW, Harrois A, Schortgen F, et al. Outcomes of extubation failure in medical intensive care unit patients. Crit Care Med, 2011, 39(12): 2612.
[14]  14. Epstein SK, Ciubotaru RL, Wong JB. Effect of failed extubation on the outcome of mechanical ventilation. Chest, 1997, 112(1): 186-192.
[15]  15. Corley A, Caruana LR, Barnett AG, et al. Oxygen delivery through high-flow nasal cannulae increase end-expiratory lung volume and reduce respiratory rate in post-cardiac surgical patients. Br J Anaesth, 2011, 107(6): 998.
[16]  16. Chanques G, Constantin JM, Sauter M, et al. Discomfort associated with under humidified high-flow oxygen therapy in critically ill patients. Intensive Care Med, 2009, 35(6): 996-1003.
[17]  17. Sztrymf B, Messika J, Mayot T, et al. Impact of high-flow nasal cannula oxygen therapy on intensive care unit patients with acute respiratory failure: A prospective observational study. J Crit Care, 2012, 27(3): 324, e9-13.
[18]  18. Sheu C C, Gong M R, Chen F, et al. Clinical characteristics and outcomes of sepsis-related vs non-sepsis-related ARDS. Chest, 2010, 138(3): 559.
[19]  19. Ware L B, Conner E R, Matthay M A. von Willebrand factor antigen is an independent marker of poor outcome in patients with early acute lung injury. Critical Care Medicine, 2001, 29(12): 2325.

Full-Text

Contact Us

service@oalib.com

QQ:3279437679

WhatsApp +8615387084133