摘要： 目的 比较重症监护室（ICU）肺癌患者拔管后应用经鼻高流量氧疗（HFNC）与储氧面罩吸氧的临床效果。方法 前瞻性分析我院ICU收治的机械通气且符合脱机标准的肺癌患者的临床资料，选取符合纳入标准的62例患者，随机分成HFNC组（A组，n=32）和储氧面罩吸氧组（B组，n=30），分别记录2组患者拔管前及拔管后1 h和12 h的心率、平均动脉压、呼吸频率、血氧饱和度、吸入氧浓度、动脉血气分析结果、机械通气时间、再插管的患者数量、ICU住院时间和ICU死亡率。结果 拔管前、拔管后1 h和12 h时2组患者比较，氧合指数的差异有统计学意义（P<0.05）。拔管后12 h时A组患者的氧分压和氧合指数高于B组，差异有统计学意义（P<0.05）。A组需要再插管的患者数量较B组少，差异有统计学意义（P<0.05）。2组患者拔管前、拔管后血流动力学指标无统计学差异，且2组患者ICU住院时间、机械通气时间和ICU死亡率均无统计学差异。结论 ICU肺癌患者拔管后序贯HFNC可获得更高的氧合指数，减少再插管风险，同时保证患者气道湿化水平、舒适度和耐受程度。

重症监护室肺癌患者拔管后经鼻高流量氧疗与储氧面罩吸氧有效性的比较

秦欢, 穆盛田, 郑振

中国医科大学肿瘤医院, 辽宁省肿瘤医院重症监护室, 沈阳 110042

收稿日期:2019-06-28出版日期:2020-04-30发布日期:2020-04-18
通讯作者:郑振E-mail:zhengzhen@cancerhosp-ln-cmu.com
作者简介:秦欢(1989-),女,主治医师,硕士.
基金资助:沈阳市科技计划（17-230-9-79）


关键词: 肺癌, 机械通气, 拔管, 经鼻高流量氧疗, 储氧面罩
Abstract: Objective To compare the efficacies of postextubation high-flow nasal cannula oxygen (HFNC) and oxygen masks in patients with lung cancer in the intensive care unit (ICU). Methods This prospective study included 62 patients with lung cancer admitted to the ICU who passed the spontaneous breathing trial. The patients were divided into groups A (receiving an HFNC,n=32) and B (receiving an oxygen mask,n=30). Data on heart rate,mean arterial pressure,respiratory rate,blood oxygen saturation,inhaled oxygen concentration,arterial blood gas analysis,duration of mechanical ventilation,number of reintubations required,length of stay in the ICU,and ICU mortality were recorded before as well as 1 and 12 h after extubation. Results A significant difference was noted in PaO₂/FiO₂ between the two groups before as well as 1 and 12 h after extubation (P<0.05). PaO₂ and PaO₂/FiO₂ were significantly higher in group A than in group B 12 h after extubation (P<0.05). Fewer patients required reintubation in group A than in group B (P<0.05). No significant difference was noted in hemodynamics,duration of mechanical ventilation,length of stay in the ICU,and ICU mortality between the two groups. Conclusion HFNC use can raise PaO₂/FiO₂;reduce the risk of reintubation;and improve airway humidification,comfort,and tolerance for the patients.
Key words: lung cancer, mechanical ventilation, extubation, high-flow nasal cannula oxygen, oxygen mask
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