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高流量鼻导管与传统氧疗对胸腔镜肺叶切除术后拔管患者的影响。

Effect of High-Flow Nasal Cannula versus Conventional Oxygen Therapy for Patients with Thoracoscopic Lobectomy after Extubation.

作者信息

Yu Yuetian, Qian Xiaozhe, Liu Chunyan, Zhu Cheng

机构信息

Department of Critical Care Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Department of Thoracic Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

出版信息

Can Respir J. 2017;2017:7894631. doi: 10.1155/2017/7894631. Epub 2017 Feb 19.

Abstract

. To investigate whether high-flow nasal cannula (HFNC) oxygen therapy is superior to conventional oxygen therapy for reducing hypoxemia and postoperative pulmonary complications (PPC) in patients with thoracoscopic lobectomy after extubation. . Patients with intermediate to high risk for PPC were enrolled in this study. Subjects were randomly assigned to HFNC group (HFNCG) or conventional oxygen group (COG) following extubation. Arterial blood samples were collected after extubation at 1, 2, 6, 12, 24, 48, and 72 h. Patients with postoperative hypoxemia and PPC were recorded. Adverse events were also documented. . Totally 110 patients were randomly assigned to HFNCG ( = 56) and COG ( = 54). The occurrence rate of hypoxemia in COG was twice more than that in HFNCG (29.62% versus 12.51%, < 0.05) and PaO, PaO/FiO, and SaO/FiO were significantly improved in HFNCG ( < 0.05) in the first 72 h following extubation. Respiratory rate and incidence of reintubation as well as needing noninvasive ventilation were also decreased in HFNCG ( < 0.05), whereas the incidence of pneumonia and atelectasis were similar ( > 0.05). Adverse effects as throat and nasal pain occurred more frequently in COG. . HFNC application improves oxygenation and reduces the risk of reintubation following thoracoscopic lobectomy but cannot decrease the incidence of PPC.

摘要

探讨高流量鼻导管(HFNC)氧疗在减少胸腔镜肺叶切除术后患者拔管后低氧血症和术后肺部并发症(PPC)方面是否优于传统氧疗。纳入PPC中高危患者进行本研究。拔管后,受试者随机分为HFNC组(HFNCG)或传统氧疗组(COG)。拔管后1、2、6、12、24、48和72小时采集动脉血样本。记录术后低氧血症和PPC患者情况。同时记录不良事件。共110例患者随机分为HFNCG组(n = 56)和COG组(n = 54)。COG组低氧血症发生率是HFNCG组的两倍多(29.62%对12.51%,P < 0.05),且拔管后前72小时HFNCG组的PaO、PaO/FiO和SaO/FiO显著改善(P < 0.05)。HFNCG组的呼吸频率、再次插管发生率以及需要无创通气的情况也降低(P < 0.05),而肺炎和肺不张的发生率相似(P > 0.05)。COG组咽喉和鼻痛等不良反应更频繁发生。HFNC应用可改善胸腔镜肺叶切除术后的氧合并降低再次插管风险,但不能降低PPC的发生率。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5961/5337350/0fb7842bb1aa/CRJ2017-7894631.001.jpg

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