高流量氧疗与无创机械通气在术后轻中度低氧血症患者中的应用效果

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摘要目的探讨高流量氧疗与无创机械通气在于术后撤机时合并轻中度低氧血症患者的应用效果。方法回顾性选取2008—2019年重症监护医疗信息数据库Ⅳ中术后入住ICU 撤机时合并轻中度低氧血症的成人患者732例作为研究对象，通过倾向性评分匹配，按照撤机后治疗方式分为高流量组（213 例）和无创通气组（213 例），比较两组患者基线数据和48 h 再插管率、28 d 再插管率、28 d 病死率、撤机至再插管时间、住院时间及住ICU 时间。再单独分析中度低氧血症患者撤机后两组的上述指标，通过倾向性评分匹配，两组各纳入73 例。结果轻中度低氧血症患者中，两组的48 h 再插管率、28 d 再插管率、28 d 病死率比较，差异均无统计学意义（P＞0.05）；高流量组住院时间、住ICU 时间、拔管后再插管时间均长于无创通气组，差异有统计学意义（P<0.05）。中度低氧血症中，两组48 h 再插管率、28 d 再插管率、28 d 病死率、撤机至再插管时间、住院时间及住ICU 时间比较，差异均无统计学意义（P＞0.05）。结论对于术后撤机时合并轻中度低氧血症的患者，高流量氧疗与无创机械通气的主要疗效指标相似，但无创机械通气患者的住院时间和住ICU 时间更短。

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	苏玲玲
	许春梅
	张爱萍
	李为春

关键词 ：高流量氧疗, 手术, 低氧血症, 无创机械通气, 重症监护医疗信息数据库

Abstract：Objective To investigate the effect of high flow oxygen therapy and non-invasive mechanical ventilation on patients with mild to moderate hypoxemia during postoperative evacuation. Methods A retrospective study of 732 adult patients with mild to moderate hypoxemia during postoperative ICU withdrawal from 2008 to 2019 was included in the Medical Information Mark for Intensive Care Ⅳ. By matching propensity score, they were divided into high-flow group(213 cases) and non-invasive ventilation group (213 cases) according to treatment mode after discontinuation of the machine. Baseline data, 48 h reintubation rate, 28 d reintubation rate, 28 d mortality, time from disengagement to reintubation, length of hospital stay and length of stay in ICU were compared between the two groups. The above indexes of moderate hypoxemia patients in the two groups were separately analyzed after discontinuation of the machine, and 73 cases in each group were included through matching propensity score. Results In patients with mild to moderate hypoxemia, there was no significant difference in the 48 h reintubation rate, 28 d reintubation rate and 28 d mortality between the two groups (P>0.05). The hospitalization time, ICU stay time and intubation time after extubation in the highflow group were longer than those in the non-invasive ventilation group, the differences were statistically significant (P<0.05). In moderate hypoxemia, there were no significant differences in 48 h reintubation rate, 28 d reintubation rate, 28 d mortality, time from discontinuation to reintubation, length of hospital stay and length of ICU stay between the two groups (P>0.05). Conclusion For patients with mild to moderate hypoxemia when weaning from ventilator, the main efficacy indicators of high-flow oxygen therapy were similar to those of non-invasive mechanical ventilation, but hospital stay and ICU stay were shorter in patients with non-invasive mechanical ventilation.

Key words： High-flow oxygen therapy Surgery Hypoxemia Non-invasive mechanical ventilation Medical Information Mart for Intensive Care

引用本文:

苏玲玲；许春梅；张爱萍；李为春. 高流量氧疗与无创机械通气在术后轻中度低氧血症患者中的应用效果[J]. 中国当代医药, 2022, 29(6): 15-19.
SU Lingling；XU Chunmei；ZHANG Aiping；LI Weichun. Application effect of high-flow oxygen therapy and non-invasive mechanical ventilation in patients with mild to moderate hypoxemia after surgery. 中国当代医药, 2022, 29(6): 15-19.

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[1]	Glossop AJ，Shepherd N，Bryden DC，et al.Non-invasive ventilation for weaning，avoiding reintubation after extubation and in the postoperative period：a meta-analysis[J].Br j anaesth，2012，109（3）：305-314.
[2]	Nishimura M.High-flow nasal cannula oxygen therapy in adults[J].J Intensive Care，2015，61（4）：529-541.
[6]	Johnson A，Bulgarelli L，Pollard T，et al.MIMIC-IV （version 0.4）[D].PhysioNet，2020.
[12]	徐秋燕，劳永光，吴兴达.经鼻高流量鼻导管湿化氧疗治疗老年重症肺炎合并呼吸衰竭的疗效评价[J].中国医药科学，2020，10（12）：194-196，226.
[15]	陈照家，吴建华.经鼻高流量湿化氧疗在Ⅱ型呼吸衰竭中的应用进展[J].疑难病杂志，2021，20（3）：310-314，319.
[3]	Hernandez G，Vaquero，Colinas L，et al.Effect of Postextubation High-Flow Nasal Cannula vs Noninvasive Ventilation on Reintubation and Postextubation Respiratory Failure in High-Risk Patients A Randomized Clinical Trial Supplemental content[J].JAMA，2016，316（15）：1565-1574.
[4]	Stéphan F，Barrucand B，Petit P，et al.High -Flow Nasal Oxygen vs Noninvasive Positive Airway Pressure in Hypoxemic Patients After Cardiothoracic Surgery：A Randomized Clinical Trial[J].JAMA，2015，313（23）：2331-2339.
[5]	Granton D，Chaudhuri D，Wang D，et al.High-Flow Nasal Cannula Compared With Conventional Oxygen Therapy or Noninvasive Ventilation Immediately Postextubation：A Systematic Review and Meta-Analysis[J].Crit care med，2020，48（11）：e1129-e1136.
[7]	Chen T，Guestrin C.XGBoost：A Scalable Tree Boosting System.Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining[C].San Francisco，California，USA：Association for Computing Machinery，2016：785-794.
[8]	Groves N，Tobin A.High flow nasal oxygen generates positive airway pressure in adult volunteers[J].Aus Crit Care，2007，20（4）：126-131.
[9]	Chikata Y，Onodera M，Oto J，et al.FIO2in an Adult Model Simulating High-Flow Nasal Cannula Therapy[J].Respir Care，2017，62（2）：193-198.
[10]	Wang Y，Huang D，Ni Y，et al.High-Flow Nasal Cannula vs Conventional Oxygen Therapy for Postcardiothoracic Surgery[J].Respir Care，2020，65（11）：1730-1737.
[11]	Futier E，Paugam-Burtz C，Godet T，et al.Effect of early postextubation high-flow nasal cannula vs conventional oxygen therapy on hypoxaemia in patients after major abdominal surgery：a French multicentre randomised controlled trial （OPERA）[J].Intensive care med，2016，42（12）：1888-1898.
[13]	Ferrer M，Sellarés J，Valencia M，et al.Non-invasive ventilation after extubation in hypercapnic patients with chronic respiratory disorders：randomised controlled trial[J].Lancet，2009，374（9695）：1082-1088.
[14]	Lee M，Choi J，Park B，et al.High flow nasal cannulae oxygen therapy in acute-moderate hypercapnic respiratory failure[J].Clin Respir J，2018，12（6）：2046-2056.
[16]	Parke R，McGuinness S，Eccleston M.Nasal high-flow therapy delivers low level positive airway pressure[J].Br janaesth，2009，103（6）：886-890.
[17]	Mller W，Celik G，Feng S，et al.Nasal High Flow Clears Anatomical Dead Space in Upper Airway Models[J].J Appl Physiol，2015，118（12）：1525-1532.
[18]	Van Hove SC，Storey J，Adams C，et al.An Experimental and Numerical Investigation of CO2Distribution in the Upper Airways During Nasal High Flow Therapy[J].Ann Biomed Eng，2016，44（10）：3007-3019.
[19]	Cirio S，Piran M，Vitacca M，et al.Effects of heated and humidified high flow gases during high-intensity constantload exercise on severe COPD patients with ventilatory limitation[J].Respir Med，2016，118：128-132.
[20]	Austin MA，Wills KE，Blizzard L，et al.Effect of high flow oxygen on mortality in chronic obstructive pulmonary disease patients in prehospital setting：randomised controlled trial[J].BMJ，2010，341：c5462.
[21]	Kang BJ，Koh Y，Lim C-M，et al.Failure of high-flow nasal cannula therapy may delay intubation and increase mortality[J].Inten Care Med，2015，41（4）：623-632.
[22]	Miltiades AN，Gershengorn HB，Hua M，et al.Cumulative Probability and Time to Reintubation in U.S.ICUs[J].Crit Care Med，2017，45（5）：835-842.
[23]	Beduneau G，Pham T，Schortgen F，et al.Epidemiology of Weaning Outcome According to a New Definition.The WIND Study[J].Am J Respir Crit Care Med，2016，195（6）：772-783.