序贯高流量气管内吸氧在脑卒中后气管切开患者脱机过程中的应用价值

doi:10.3969/j.issn.1002-1949.2019.10.009

Chinese Journal of Critical Care Medicine

2019, Vol. 39

Issue (10): 963-966 DOI: 10.3969/j.issn.1002-1949.2019.10.009

The application value of sequential high flow endotracheal oxygen inhalation on the patients with stroke in the weaning from mechanical ventilation process after tracheotomy

Lu Jian, Ni Xing-mei, Shen Yi

Dapartment of Emergency and Intensive Care Unit, Suzhou Hospital Affiliated to Nanjing Medical University, Suzhou 215002, China

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Abstract Objective To evaluate the feasibility and clinical efficacy of sequential treatment of high flow endotracheal oxygen inhalation (HFETOI) in patients with stroke after tracheotomy in the course of weaning ventilation. Methods The 45 patients who were hospitalized due to stroke and tried weaning from invasive mechanical ventilation after tracheostomy from Jan 2015 to Dec 2018 in emergency and intensive care unit department of Suzhou Hospital Affiliated to Nanjing Medical University were divided into HFETOI (22 cases) or tracheotomy mask oxygen inhalation (TMOI) (23 cases) group by the method of cohort study. Heart rate, respiratory frequency, blood pressure and sputum viscosity of the patients were recorded at 0, 6, 12, 24 and 48 hours after sequential treatment, and para-bed arterial blood gas analysis were performed. The total time of mechanical ventilation support again within 1 week was calculated, and the improvement effect of HFETOI or TMOI on the oxygenation after tracheotomy was analyzed. Results There were statistically significant differences in heart rate (HR) of the HFETOI group comparing to TMOI group after 12 h (82.4±18.4 vs. 90.4±16.7), 24 h (79.8±16.8 vs. 88.4±14.6) and 48 h (78.4±17.1 vs. 87.4±12.4) of sequential treatment (P＜0.05), the respiratory rate (RR) of HFETOI group was statistically different comparing to TMOI after 24 h (17.2±4.1 vs. 22.4±5.4) and 48 h (15.6±3.9 vs. 21.6±5.2) of sequential treatment (P＜0.05), and no statistically significant differences in mean arterial pressure (MAP) between the two groups (P＞0.05). The arterial partial pressure of oxygen (PaO2) after 12 h (89.6±15.6 vs. 79.9±16.7), 24 h (93.8±21.5 vs. 80.2±19.6) and 48 h (94.2±18.1 vs. 84.6±18.4) of sequential treatment in HFETOI group was statistically significant compared with that in TMOI group (P＜0.05). The cases of sputum viscosity attenuating 48 h after sequential treatment in HFETOI group were statistically different to TMOI group (P＜0.05). Compared with TMOI group, HFETOI group reduced the total time (12.2±8.3 vs. 21.4±11.5) required for re-mechanical ventilation support within 1 week of sequential treatment, and the difference was statistically significant (P＜0.05). Conclusion After tracheotomy, the sequential HFETOI in the process of weaning can help stroke patients maintain stable heart and respiratory rate, effectively dilute sputum and improve arterial oxygen pressure, reduce the support of mechanical ventilation to achieve the goal of weaning completely.

Key words： High flow inhalation Stroke Tracheotomy Weaning from mechanical ventilation

Corresponding Authors: Shen Yi, E-mail: shenyi410@163.com

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Lu Jian,Ni Xing-mei,Shen Yi. The application value of sequential high flow endotracheal oxygen inhalation on the patients with stroke in the weaning from mechanical ventilation process after tracheotomy[J]. Chinese Journal of Critical Care Medicine, 2019, 39(10): 963-966.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2019.10.009 OR http://www.cnemergency.org.cn/EN/Y2019/V39/I10/963

［1］Lioutas VA, Hanafy KA, Kumar S. Predictors of extubation success in acute ischemic stroke patients［J］. J Neurol Sci, 2016, 368: 191-194. ［2］Rollnik JD, Krauss JK, Gutenbrunner C, et al. Weaning of neurological early rehabilitation patients from mechanical ventilation: a retrospective observational study［J］. Eur J Phys Rehabil Med, 2017, 53(3): 441-446. ［3］张翔宇，景炳文，杨兴易，等. 机械通气患者的脱机(附85例分析)［J］. 中华危重病急救医学， 1994， 5: 267-269. ［4］沈梅芬，张海英. 脑外伤患者气管切开后不同黏稠度痰液适宜吸痰负压的临床研究［J］. 中华护理杂志， 2009， 44(8): 694-697. ［5］Chatterjee A, Chen M, Gialdini G, et al. Trends in tracheostomy after stroke: analysis of the 1994 to 2013 national inpatient sample［J］. Neurohospitalist, 2018, 8(4): 171-176. ［6］Khammas AH, Dawood MR. Timing of tracheostomy in intensive care unit patients［J］. Int Arch Otorhinolaryngol, 2018, 22(4): 437-442. ［7］Mitaka C, Odoh M, Satoh D, et al. High-flow oxygen via tracheostomy facilitates weaning from prolonged mechanical ventilation in patients with restrictive pulmonary dysfunction: two case reports［J］. J Med Case Rep, 2018, 12(1): 292. ［8］Masclans JR, Pérez-Terán P, Roca O. The role of high flow oxygen therapy in acute respiratory failure［J］. Med Intensiva, 2015, 39(8): 505-515. ［9］Slain KN, Shein SL, Rotta AT. The use of high-flow nasal cannula in the pediatric emergency department［J］. J Pediatr (Rio J), 2017, 93 (Suppl 1): 36-45. ［10］Zhang J, Lin L, Pan K, et al. High-flow nasal cannula therapy for adult patients［J］. J Int Med Res, 2016, 44(6): 1200-1211. ［11］孙长宁. 经鼻高流量吸氧对急性呼吸衰竭患者氧疗和气道湿化效果观察［J］. 锦州医科大学学报， 2018， 39(5): 45-48. ［12］Huang HW, Sun XM, Shi ZH. Effect of high-flow nasal cannula oxygen therapy versus conventional oxygen therapy and noninvasive ventilation on reintubation rate in adult patients after extubation: a systematic review and meta-analysis of randomized controlled trials［J］. J Intensive Care Med, 2018, 33(11): 609-623. ［13］Di Mussi R, Spadaro S, Stripoli T. et al. High-flow nasal cannula oxygen therapy decreases postextubation neuroventilatory drive and work of breathing in patients with chronic obstructive pulmonary disease［J］. Crit Care, 2018, 22(1): 180.