摘要： 目的 探讨与传统的球囊面罩通气预氧合相比，经鼻高流量氧疗（HFNC）预氧合在慢性阻塞性肺疾病（COPD）患者心肺复苏后气管插管中的有效性。方法 将接受心肺复苏且行气管插管的158例COPD患者，根据插管预氧合方式分为HFNC组（HFNC预氧合）和对照组（球囊面罩通气预氧合）。比较2组患者插管开始和插管成功即刻的白细胞介素（IL）-6和IL-8水平、动脉血氧饱和度、收缩压；插管过程脉搏血氧饱和度、插管安全时限和成功插管时间；插管后循环恢复情况、插管并发症发生率和死亡率。结果 与对照组相比，HFNC组插管安全时限明显延长，呼吸循环恢复率高（均P < 0.05）。插管开始时，2组比较IL-6和IL-8水平无统计学差异（P > 0.05） ；插管成功即刻，HFNC组IL-6和IL-8水平明显低于对照组（均P < 0.05）。HFNC组气管插管过程血氧、血压水平更趋于平稳，死亡率和成功插管时间明显低于对照组（均P < 0.05）。结论 COPD患者在心肺复苏气管插管前应用HFNC预氧合，有助于维持恒定高脉搏血氧饱和度，改善乏氧状态，通过延长插管安全时限提高气管插管成功率，降低炎性细胞因子水平和并发症发生率，使患者获得较好的治疗和预后，值得临床推广。

经鼻高流量氧疗预氧合在慢性阻塞性肺疾病患者心肺复苏后气管插管中的有效性

李旭, 许莹, 刘洁

中国医科大学附属盛京医院呼吸科, 沈阳 110004

收稿日期:2021-04-23出版日期:2022-02-28发布日期:2022-01-05
通讯作者:李旭E-mail:1013100172@qq.com
作者简介:李旭(1989-),女,主管护师,本科.
基金资助:辽宁省自然科学基金（2021-MS-189）


关键词: 心肺复苏, 气管插管, 经鼻高流量氧疗, 炎性细胞因子, 血氧饱和度
Abstract: Objective To evaluate the efficacy of preoxygenation with high-flow nasal cannula oxygen therapy (HFNC) during tracheal intubation after cardiopulmonary resuscitation in patients with chronic obstructive pulmonary disease (COPD). Methods A total of 158 COPD patients who underwent tracheal intubation after cardiopulmonary resuscitation were enrolled and divided into HFNC and control groups, in which patients received preoxygenation with HFNC and bag-mask ventilation, respectively. The arterial oxygen saturation, systolic blood pressure, and the serum levels of interleukin (IL) -6 and IL-8 during tracheal intubation were compared. The safety, complications, mortality, and prognosis of tracheal intubation were evaluated. Results The safety of tracheal intubation was significantly improved, and vital signs recovered faster in the HFNC group, compared with the control group (P < 0.05). No significant difference in the serum levels of IL-6 and IL-8 was found between the two groups before tracheal intubation (P > 0.05), whereas they significantly decreased in the HFNC group after tracheal intubation (P < 0.05). Compared with the control group, patients in the HFNC group had stable arterial oxygen saturation and blood pressure during tracheal intubation and lower mortality. Conclusion Compared with the preoxygenation with bag-mask ventilation, that with HFNC during tracheal intubation could improve the safety and prognosis of cardiopulmonary resuscitation in patients with COPD and decrease the inflammatory response and incidence of complications. This study demonstrates the clinical value of HFNC during tracheal intubation after cardiopulmonary resuscitation in patients with COPD.
Key words: cardiopulmonary resuscitation, tracheal intubation, high-flow nasal cannula oxygen therapy, inflammatory cytokine, oxygen saturation
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