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目的:探讨高流量氧疗与无创通气用于胸部大术后呼吸功能不全的临床疗效及安全性。方法:将62例接受胸部大术后发生急性呼吸功能不全的患者随机分为氧疗组和经鼻持续气道正压通气(NCPAP)组,每组各31例。两组分别给予高流量氧疗和NCPAP,比较两组患者的血气指标、临床疗效及并发症的发生情况。结果:通气后2 h,氧疗组患者的pH、PaO_2、SpO_2明显上升,且明显高于NCPAP组(P<0.05);通气后12 h后,两组pH、PaO_2、SpO_2比较差异均无统计学意义(P>0.05);与NCPAP组比较,氧疗组吸痰次数、痰痂形成比例明显减少,痰液粘稠度也明显减轻(P<0.05);两组住院时间、ICU停留时间、辅助通气时间比较差异均无统计学意义(P>0.05);氧疗组气漏、呼吸道粘膜出血、肺部感染的发生率均显著低于NCPAP组(P<0.05)。结论:高流量氧疗在改善胸部大术后呼吸功能不全的动脉血气方面临床疗效与NCPAP相当,但其对气道损伤小,可促进痰液排出,降低感染的发生。
Objective: To investigate the clinical efficacy and safety of high-flow oxygen therapy and noninvasive ventilation for respiratory insufficiency after thoracic surgery. Methods: Sixty-two patients with acute respiratory insufficiency after thoracic surgery were randomly divided into oxygen therapy group and nasal continuous positive airway pressure (NCPAP) group, 31 cases in each group. Two groups were given high-flow oxygen therapy and NCPAP respectively. Blood gas indexes, clinical efficacy and complications of the two groups were compared. Results: At 2 h after ventilation, the pH, PaO 2 and SpO 2 in oxygen therapy group increased significantly and were significantly higher than those in NCPAP group (P <0.05). After 12 h of ventilation, there was no statistical difference in pH, PaO 2 and SpO 2 (P> 0.05). Compared with NCPAP group, the number of sputum suction and sputum scab formation in oxygen therapy group decreased significantly and the viscosity of sputum also significantly reduced (P <0.05). The length of hospital stay, ICU stay, (P> 0.05). The incidence of air leaks, respiratory mucosal hemorrhage and pulmonary infection in oxygen therapy group were significantly lower than those in NCPAP group (P <0.05). CONCLUSION: High flow oxygen therapy has the same clinical effect as NCPAP in improving arterial blood gas after thoracic surgery, but it has less damage to airway and can promote sputum excretion and reduce the incidence of infection.