作　　者： (林炳文）; (陈名智）; (肖雄箭）; (林建东）;

机构地区： 福建医科大学附属第一医院ICU,福建福州350005

出　　处： 《中国急救医学》 2017年第9期803-807,共5页

摘　　要： 目的 探讨高流量氧疗在ICU机械通气患者脱机过程中的应用效果。方法 105例ICU中因呼吸衰竭行机械通气治疗后脱机但未拔管的患者，采用随机数值表法分为研究组和对照组。研究组采用气管插管处接高流量氧疗系统行氧疗湿化治疗，对照组采用气管插管处接人工鼻联合文丘里空氧混合阀行传统氧疗。监测比较脱机后6、12、24 h两组患者的呼吸频率、动脉血pH、PaO2、氧合指数（PaO2/FiO2）、PaCO2、气道湿化效果、纤支镜吸痰次数。比较脱机期间两组患者再上机率、拔管后无创呼吸机使用率、拔管后72 h内再插管率及ICU住院天数。结果 氧疗后6、12、24 h研究组患者的呼吸频率、PaO2、氧合指数均优于对照组（P〈0.01）；两组动脉血pH、PaCO2比较差异无统计学意义（P〉0.05）；研究组气道湿化效果优于对照组（P〈0.01），纤支镜吸痰次数较对照组少（2.1±1.3 vs. 3.0±1.3,P〈0.01）。研究组脱机期间再上机率低于对照组（11.8% vs. 29.6%，P〈0.05），两组拔管后无创呼吸机使用率（17.6% vs. 31.5%，P〉0.05），拔管后72 h内再插管率（7.8% vs. 18.5%，P〉0.05）以及ICU住院天数（14.3±3.0 vs. 14.3±3.3，P〉0.05）比较差异无统计学意义。结论 高流量氧疗系统可以降低ICU机械通气患者脱机后的呼吸频率，改善氧合，提高气道湿化效果,减少纤支镜吸痰次数，并降低脱机后再上机率，但拔管后无创呼吸机使用率、72 h内再插管率和ICU住院天数差异无统计学意义。 Objective To investigate the efficiency of the high flow oxygen therapy on mechanical ventilation patients with artificial airway during the weaning process in ICU. Methods 105 patients weaning from mechanical ventilation due to respiratory failure and not yet extnbated were investigated, The patients were randomly divided into two groups by computer generated random numbers table. The patients in the study group received the high flow oxygen therapy through trachea eannula, while using artificial nose combined with Venturi air oxygen mixing valve for conventional oxygen therapy in the control group. The respiratory rate, pH, PaO2, PaO2/FiO2, PaCO2 at different times （6, 12, 24 h after weaning）, airway humidification and times of sputum aspiration by the fiberoptic bronchoscopy were compared between the two groups. The rate of mechanical ventilation reuse after weaning, the rate of noninvasive ventilator use after extubation, re - intubation rate within 72 h after extubation and ICU duration were also compared between the two groups. Results Compared with the control group, the respiratory rate at different times （6, 12, 24 h after oxygen therapy） was lower in the study group （P 〈 0.01） and PaO2, PaO2/Fio2 was higher in the study group （P 〈0.01 ）. No difference showed in pH, PaCO2 between two groups （ P 〉 0.05 ）. The effect of airway humidification was better in the study group （P 〈 0.01 ）, and less of times of sputum aspiration showed in the study group （2.1 ±1. 3 vs. 3.0 ±1.3, P 〈0.01 ） ; The rate of mechanical ventilation reuse after weaning was lower in the study group （ 11.8% vs. 29.6%, P 〈 0.05 ）. But no statistically difference showed in the rate of noninvasive ventilator use after extubation （17.6% vs. 31.5% , P 〉0.05）, re - intubation rate within 72 h after extubation （7.8% vs. 18.5%, P〉0.05） and ICU duration （14.3±3.0 vs. 14.3±3.3, P〉0.05）. Conclusion For the patients weaning from mechanical ventilation in the ICU, high flow oxygen therap

关 键 词： 高流量氧疗 呼吸衰竭 机械通气 脱机 无创通气