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机械通气撤离序贯治疗中应用HFNC对重症肺炎患者的临床效果

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目的 探讨机械通气撤离序贯治疗中应用经鼻高流量湿化氧疗(High flow nasal can-nula,HFNC)对重症肺炎患者的临床效果,并分析该方案对患者撤离24 h后痰液湿化与动脉血氧分压的影响.方法 选取2019年1月-2022年12月118例上海健康医学院附属崇明医院收治的重症肺炎患者,采用随机数字表法将其分为对照组和试验组,各59例,对照组患者接受无创正压通气,试验组患者接受HFNC,比较两组患者临床指标(总机械通气时间、住院时间)、撤离24 h后痰液湿化效果、痰液黏稠度、血气指标[动脉血氧分压(PaO2)]、二氧化碳分压(PaCO2)、生命体征(呼吸频率、心率)、再插管率、不良反应发生情况.结果 试验组患者总机械通气时间和住院时间均短于对照组(P<0.05).试验组湿化满意率(81.36%)较对照组(49.15%)高,差异有统计学意义(P<0.05).试验组中痰液黏稠度Ⅰ度、Ⅱ度和Ⅲ度患者分别为31例(52.54%)、24例(40.68%)和4例(6.78%),与对照组患者痰液黏稠度之间差异有统计学意义(P<0.05).治疗后,两组患者PaO2均上升,PaCO2均下降,且试验组PaO2显著高于对照组,PaCO2显著低于对照组(P<0.05);两组患者呼吸频率和心率均下降,且试验组呼吸频率和心率均显著低于对照组(P<0.05).试验组患者再插管率(3.39%)较对照组(18.64%)低,不良反应发生率(8.47%)较对照组(32.20%)低,差异有统计学意义(P<0.05).结论 在机械通气撤离序贯治疗中给予重症肺炎患者HFNC治疗能促进患者恢复,改善患者撤机后24 h的痰液湿化效果、痰液黏稠度、患者血氧状态和生命体征,降低不良反应发生率和再插管率.
Clinical effect of HFNC in mechanical ventilation evacuation sequential therapy for patients with severe pneumonia
Objective To investigate the clinical efficacy of high flow nasal cannula(HFNC)in sequential mechanical ventilation evacuation therapy for severe pneumonia patients,and to analyze the impact of the regimen on sputum humidification and arterial oxygen partial pressure after 24 hours of evacuation.Meth-ods A total of 118 severe pneumonia patients admitted to Chongming Hospital Affiliated to Shanghai Medical College of Health from January 2019 to December 2022 were selected.The patients were randomly divided into a control group and an experimental group,with 59 patients in each group using a random number table method.The control group received non-invasive positive pressure ventilation,while the ex-perimental group received HFNC.Clinical indicators(total mechanical ventilation time,hospital stay),sputum wetting effect after 24 hours of evacuation,and sputum viscosity were compared between the 2 groups blood gas indicators[arterial oxygen partial pressure(PaO2),carbon dioxide partial pressure(PaCO2),vital signs(respiratory rate,heart rate),reintubation rate,incidence of adverse reactions].Re-suIts The total mechanical ventilation time and hospitalization time of the experimental group patients were shorter than those of control group(P<0.05).The satisfaction rate of humidification in the experi-mental group(81.36%)was higher than that in control group(49.15%),and the difference was statisti-cally significant(P<0.05).In the experimental group,there were 31 patients(52.54%),24 patients(40.68%)and 4 patients(6.78%)with sputum viscosity of grade Ⅰ,Ⅱ,and Ⅲ,respectively.The difference in sputum viscosity between the experimental group and the control group was statistically sig-nificant(P<0.05).After thetreatment,both groups of the patients had an increase in PaO2 and a de-crease in PaCO2,and the experimental group had significantly higher PaO2 than the control group,while PaCO2 was significantly lower than the control group(P<0.05).After thetreatment,the respiratory rate and heart rate of both groups of the patients wasdecreased,and the respiratory rate and heart rate of the experimental group were significantly lower than those of the control group(P<0.05).The reintubation rate of the patients in the observation group(3.39%)was lower than that in the control group(18.64%),and the incidence of adverse reactions(8.47%)was lower than that in the control group(32.20%),with a statistically significant difference(P<0.05).Conclusion Providing HFNC treatment to SP patients during mechanical ventilation evacuation sequential treatment can promote patient recovery,improve the sputum wetting effect and viscosity 24 hours after evacuation,improve the patient's blood oxygen status and vital signs,and reduce the incidence of adverse reactions and reintubation rates.

sequential treatment of mechanical ventilation evacuationhigh-flow nasal cannula oxygen ther-apysevere pneumoniaphlegm humidificationarterial partial pressure of oxygen

陆逸倩、张玲、曹玲、王强

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上海健康医学院附属崇明医院呼吸胸外科,上海 202150

机械通气撤离序贯治疗 经鼻高流量湿化氧疗 重症肺炎 痰液湿化 动脉血氧分压

上海市科技计划项目

19Y11392821

2024

新疆医科大学学报
新疆医科大学

新疆医科大学学报

CSTPCD
影响因子:0.76
ISSN:1009-5551
年,卷(期):2024.47(1)
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