2022 年第 4 期 第 17 卷

经鼻高流量氧疗与无创机械通气在急性呼吸衰竭患者拔管后序贯治疗中的效果比较

Comparison of high flow nasal cannula with noninvasive ventilation in acute respiratory failure patients with sequential treatment of postextubation

作者：王生浩温林芳杜小兵李梅刘双

英文作者：Wang Shenghao Wen Linfang Du Xiaobing Li Mei Liu Shuang

单位：北京大学国际医院呼吸与危重症医学科，北京102206

英文单位：Department of Respiratory and Critical Care Medicine Peking University International Hospital Beijing 102206 China

关键词：呼吸衰竭；经鼻高流量氧疗；机械通气minor-latin'>温林芳杜小兵李梅刘双

英文关键词：Respiratoryfailure;Highflownasalcannula;Mechanicalventilation

• 摘要：

• 目的 比较经鼻高流量氧疗（HFNC）与无创机械通气（NIV）在急性呼吸衰竭患者机械通气拔管后序贯治疗中的效果。方法 回顾性分析2017年11月至2021年6月北京大学国际医院呼吸重症监护病房（RICU）收治的72例因急性呼吸衰竭行气管插管患者的临床资料。根据拔管后序贯治疗方式将其分为HFNC组（41例）和NIV组（31例）。记录患者的基线资料，比较2组拔管前及拔管后2、24、48 h动脉血气分析结果、RICU住院时间、再插管率和住院病死率。结果 拔管前，2组氧合指数比较差异无统计学意义（P＞0.05）。HFNC组拔管后2 h氧合指数明显高于NIV组［（304±60）mmHg（1 mmHg=0.133 kPa）比（260±81）mmHg］（P＜0.05），但2组拔管后24、48 h比较差异均无统计学意义（均P＞0.05）。拔管前，HFNC组动脉血二氧化碳分压（PaCO2）低于NIV组［（39.2±9.2）mmHg比（48.8±8.9）mmHg］（P＜0.001）。协变量调整后2组拔管后2、24、48 h PaCO2比较，差异均无统计学意义（均P＞0.05）。NIV组拔管前后各时点PaCO2比较差异无统计学意义（P＞0.05）；HFNC组拔管后48 h PaCO2高于拔管前和拔管后2 h（均P＜0.05）。2组RICU住院时间、再插管率及住院病死率比较差异均无统计学意义（均P＞0.05）。结论 急性呼吸衰竭患者机械通气拔管后接受HFNC与NIV均能改善并维持氧合状况，虽然HFNC会导致PaCO2轻度升高，但二者临床转归相似。

• Objective To compare the effects between high flow nasal cannula (HFNC) and noninvasive ventilation (NIV) on sequential treatment of patients with acute respiratory failure after mechanical ventilation extubation. Methods From November 2017 to June 2021, clinical data of 72 patients with acute respiratory failure who underwent endotracheal intubation mechanical ventilation admitted to Respiratory Intensive Care Unit (RICU), Peking University International Hospital were retrospectively analyzed. They were divided into HFNC group (41 cases) and NIV group (31 cases) according to the approach of sequential treatment after extubation. The baseline data of patients were recorded. Results  of arterial blood gas analysis before extubation and 2, 24 and 48 h after extubation, length of RICU stay, reintubation rate and hospital mortality were compared between the two groups. Results Before extubation, there was no significant difference in oxygenation index between the two groups (P>0.05). The oxygenation index 2 h after extubation in HFNC group was higher than that in NIV group［(304±60)mmHg vs (260±81)mmHg］(P<0.05), but there were no differences between the two groups 24 and 48 h after extubation(both P>0.05). Before extubation, the partial pressure of arterial carbon dioxide (PaCO2) in HFNC group was lower than that in NIV group ［(39.2±9.2)mmHg vs (48.8±8.9)mmHg］(P<0.001). After covariate adjustment, there were no differences in PaCO2 2, 24 and 48 h after extubation between the two groups (all P>0.05). There was no difference in PaCO2 in NIV group before and after extubation (P>0.05). In HFNC group, PaCO2 48 h after extubation was higher than that before extubation and 2 h after extubation (both P<0.05). There were no significant differences in length of RICU stay, reintubation rate and hospital mortality between the two groups (all P>0.05). Conclusions Both HFNC and NIV can improve oxygenation in patients with acute respiratory failure after mechanical ventilation extubation. Although HFNC mildly increases PaCO2, the clinical outcomes between the two groups are similar.