罗艳 邓红妹

[摘要]目的 探讨高流量氧气湿化治疗在ICU气管插管患者拔管后的应用效果，为ICU气管插管患者拔管后的有效护理提供参考依据。方法 选取2016年5月～2017年10月我院重症医学科收治的80例行气管插管拔管后的患者，随机分为对照组和实验组，每组各40例。对照组采用常规氧疗，实验组采用高流量氧气湿化氧疗，比较两组气管黏膜损伤、肺部感染、再次插管发生率及通气效果。结果 实验组气管黏膜损伤、肺部感染及再次插管发生率均明显低于对照组（P<0.05）；拔管后24 h，实验组PaO2、PaCO2及BE均优于对照组，差异均有统计学意义（P<0.05）。结论 高流量氧气湿化治疗对ICU气管插管拔管后患者呼吸道黏膜有保护作用，有利于预防呼吸道并发症及再次插管，改善通气效果。

[关键词]高流量氧气湿化；危重症患者；气管插管；拔管后

[中图分类号] R472 [文献标识码] A [文章编号] 1674-4721（2018）9（a）-0215-03

[Abstract] Objective To explore the effect of high flow oxygen humidification treatment in ICU patients with tracheal intubation after extubation， and to provide reference for effective nursing of ICU tracheal intubation patients after extubation. Methods Totally 80 ICU patients with tracheal intubation after extubation from May 2016 to October 2017 were selected and divided randomly in the control group and the experimental group， 40 cases in each group. The control group was treated with conventional oxygen therapy， and the experimental group was treated with high flow oxygen humidification oxygen therapy. The incidence of the injury of trachea mucosa， lung infection， and reintubation were compared between the two groups， as well as the effect of ventilation. Results The incidence of tracheal mucosa injury， pulmonary infection and reintubation in the experimental group was significantly lower than that of the control group （P<0.05）. After extubation 24 h， PaO2， PaCO2 and BE in the experimental group were better than those in the control group， the differences were statistically significant （P<0.05）. Conclusion High flow oxygen humidification treatment can significantly reduce the incidence of respiratory complications and reintubation in ICU patients with tracheal intubation after extubation， and improve ventilation effect.

[Key words] High flow oxygen humidification； Critically ill patients； Endotracheal intubation； After extubation

重癥监护室（ICU）以收治病情危重多变的患者为主，需随时面临患者的抢救。气管插管因其操作简单、效果可靠，被广泛用于ICU危重患者的急救。但气管插管也可使患者正常的结构功能受到影响，失去鼻部对吸入气体加温、加湿及净化的作用，因此，进行有效的人工气道管理、及早拔除气管插管是促进患者顺利康复的关键因素[1]。目前，临床上气管插管患者拔管后一般采用普通鼻导管或面罩给氧，但由于这类氧疗方式没有加温装置，湿化效果不可控，当氧流量偏大时，患者容易出现呼吸道干燥、鼻咽部不适等症状[2]。如何为气管插管患者拔管后提供安全、有效的氧疗一直是临床关注的重点问题。高流量氧气湿化治疗（humidified high-flow nasal cannulae，HHFNC）是一种区别于传统低流速氧疗的治疗方法，其可灵活控制吸入气体的温度和湿度、具有气道正压支持等优点，近年来正逐渐应用于临床患者的氧疗中[3]，但目前关于其对气管插管患者拔管后的应用效果主要以国外研究为主[4-5]，国内相关研究尚不多见。……