急性呼吸衰竭患者拔管后高流量鼻导管氧疗的价值。
The value of high-flow nasal cannula oxygen therapy after extubation in patients with acute respiratory failure.
机构信息
Department of Critical Care Medicine, Haining People's Hospital, Zhejiang, China.
Department of Critical Care Medicine, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
出版信息
Clinics (Sao Paulo). 2017 Oct;72(9):562-567. doi: 10.6061/clinics/2017(09)07.
OBJECTIVE
To investigate the value of high-flow nasal cannula oxygen therapy after extubation in patients with acute respiratory failure.
METHODS
A single-center, prospective, randomized, controlled pilot trial was conducted between January 2013 and December 2014. Sixty enrolled patients were randomized immediately after extubation into either a high-flow nasal cannula group (n=30) or an air entrainment mask group (n=30) at a fixed inspired oxygen fraction (40%). The success rate of oxygen therapy, respiratory and hemodynamic parameters and subjective discomfort (using a visual analogue scale) were assessed at 24h after extubation.
RESULTS
The two groups were comparable at extubation. A total of 46 patients were successfully treated including 27 patients in the high-flow nasal cannula group and 19 patients in the air entrainment mask group. Compared to the air entrainment mask group, the success rate of oxygen therapy and the partial pressure of arterial oxygen were significantly higher and the respiratory rate was lower in the high-flow nasal cannula group. In addition, less discomfort related to interface displacement and airway dryness was observed in the high-flow nasal cannula group than in the air entrainment mask group.
CONCLUSIONS
At a fixed inspired oxygen fraction, the application of a high-flow nasal cannula after extubation achieves a higher success rate of oxygen therapy and less discomfort at 24h than an air entrainment mask in patients with acute respiratory failure.
目的
探讨急性呼吸衰竭患者拔管后高流量鼻导管氧疗的价值。
方法
采用单中心前瞻性随机对照初步临床试验，于 2013 年 1 月至 2014 年 12 月期间进行。将 60 例入选患者在拔管后立即随机分为高流量鼻导管组（n=30）或空气混合面罩组（n=30），固定吸入氧分数（40%）。在拔管后 24 小时评估氧疗成功率、呼吸和血流动力学参数以及主观不适（使用视觉模拟评分）。
结果
两组在拔管时具有可比性。共有 46 例患者成功治疗，其中高流量鼻导管组 27 例，空气混合面罩组 19 例。与空气混合面罩组相比，高流量鼻导管组的氧疗成功率和动脉血氧分压更高，呼吸频率更低。此外，高流量鼻导管组与界面移位和气道干燥相关的不适程度低于空气混合面罩组。
结论
在固定吸入氧分数下，急性呼吸衰竭患者拔管后应用高流量鼻导管在 24 小时时的氧疗成功率更高，舒适度更好，而空气混合面罩则较低。
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