文章摘要
周本昊,姜 超,韩云宏,王 研,杜 成.经鼻高流量氧疗在基于膈肌浅快呼吸指数评估的高风险脱机患者中的应用[J].南京医科大学学报,2021,(1):109~113
经鼻高流量氧疗在基于膈肌浅快呼吸指数评估的高风险脱机患者中的应用
The application of high⁃flow nasal cannula in high⁃risk patients of extubation failure assessed by the diaphragmatic⁃rapid shallow breathing index
投稿时间:2020-02-12  
DOI:10.7655/NYDXBNS20210120
中文关键词: 经鼻高流量氧疗  常规氧疗  膈肌浅快呼吸指数  脱机
英文关键词: high⁃flow nasal cannula  conventional oxygen therapy  the diaphragmatic⁃rapid shallow breathing index  extubation
基金项目:北京医卫健康公益基金会医学科学研究基金医学科研项目(YWJKJJHKYJJ?F2246E)
作者单位
周本昊 南京医科大学附属脑科医院(胸科院区)重症医学科江苏 南京 210029 
姜 超 南京中医药大学附属医院肿瘤外科江苏 南京 210029 
韩云宏 南京医科大学附属脑科医院(胸科院区)重症医学科江苏 南京 210029 
王 研 南京医科大学附属脑科医院(胸科院区)重症医学科江苏 南京 210029 
杜 成 南京医科大学附属脑科医院(胸科院区)重症医学科江苏 南京 210029 
摘要点击次数: 0
全文下载次数: 0
中文摘要:
      目的:探讨经鼻高流量氧疗(high?flow nasal cannula,HNFC)在基于超声测量膈肌浅快呼吸指数(diaphragmatic?rapid shallow breathing index,D?RSBI)评估的高风险脱机拔管患者中的应用价值。方法:选取2017年9月—2019年11月南京医科大学附属脑科医院(胸科院区)ICU机械通气大于48 h的患者,在通过自主呼吸试验符合脱机拔管程序基础上,使用超声测量D?RSBI,以D?RSBI≥1.3次/(min·mm)评估为高风险脱机患者,将该类患者随机分为两组:HNFC组和常规氧疗(conventional oxygen therapy,COT)组;比较两组患者拔除气管插管后48 h内再插管率及拔管后6、24、48 h呼吸频率(RR)、心率(HR)、动脉血氧饱和度(SaO2)、动脉血二氧化碳分压(PaCO2)、氧合指数(PaO2/FiO2)。结果:本研究最终纳入符合入组标准的患者共41例,其中HFNC组21例,COT组20例;拔除气管插管后6、24 h HFNC组RR、HR、SaO2、PaO2/FiO2均优于COT组,差异有统计学意义(P < 0.05),PaCO2两组差异无统计学意义(P > 0.05);拔管后48 h HFNC组SaO2、PaO2/FiO2明显高于COT组(P < 0.05),差异有统计学意义,RR、HR、PaCO2两组差异无统计学意义(P > 0.05)。HNFC组拔管后48 h内再插管率明显低于COT组(4.76% vs.30.00%,P < 0.01)。结论:针对基于D?RSBI评估的高风险脱机拔管患者,拔管后使用经鼻高流量氧疗较常规氧疗可以明显改善患者的呼吸及氧合情况,降低再插管率,是一种比较理想的序贯治疗策略。
英文摘要:
      Objective:To investigate the application value of high?flow nasal cannula (HFNC)in high?risk patients with extubation failure based on the ultrasound?measured diaphragmatic?rapid shallow breathing index (D?RSBI). Methods:Patients with mechanical ventilation for more than 48 hours in ICU from September 2017 to November 2019 were selected. Based on the extubation procedure after the SBT,their D?RSBI was measured using ultrasound and those whose D?RSBI ≥ 1.3 times/(min·mm) were evaluated as high?risk patients with extubation failure,who were randomized into two groups:HFNC group and conventional oxygen therapy group (COT group);The re?intubation rate at 48 h after extubation and,respiratory rate (RR),heart rate (HR),arterial oxygen saturation (SaO2),arterial carbon dioxide partial pressure (PaCO2),oxygenation index (PaO2/FiO2)after extubation at 6 h,24 h,48 h were compared between the two groups. Results:A total of 41 patients who met the inclusion criteria were finally included in this study,of which 21 were in the HFNC group and 20 were in the COT group;RR,HR,SaO2,PaO2/FiO2 in the HFNC group were superior to the COT group at 6,24 h after extubation,the difference was statistically significant (P < 0.05);and there was no significant difference between the two groups of PaCO2(P > 0.05);SaO2,PaO2/FiO2 in the HFNC group was significantly higher than that in the COT group 48 h after extubation,and the difference was statistically significant (P < 0.05);and there was no significant difference between the two groups of RR,HR,and PaCO2 (P > 0.05). The re?intubation rate at 48 h after extubation in the HNFC group was 4.76%,the re?intubation rate in the COT group was 30.00%,and the difference was statistically significant (P < 0.01). Conclusion:For patients with high?risk of extubation failure based on D?RSBI assessment,the use of HFNC after extubation can significantly improve the patient’s respiratory function and oxygenation,and significantly reduce the re?intubation rate,which is an ideal sequential treatment strategy.
查看全文   查看/发表评论  下载PDF阅读器