作者：李丹，高胜浩，安君娜，张婷，程剑剑，马利军，张晓菊，李震宇，王东平，李轩轩，黄泰博，王海播

单位：

450003河南省郑州市，河南省人民医院 郑州大学人民医院 河南大学人民医院呼吸与危重症医学科 通信作者：王海播，E-mail：haiboqwzx815815@163.com

Units：

Department of Respiratory and Critical Care Medicine, Henan Provincial People's Hospital/People's Hospital of ZhengzhouUniversity/People's Hospital of Henan University, Zhengzhou 450003, China Corresponding author: WANG Haibo, E-mail: haiboqwzx815815@163.com

关键词：

呼吸功能不全; 呼吸机依赖; 气管切开; 无创正压机械通气; 无创序贯降级治疗;

Keywords：

Respiratory insufficiency; Ventilator-dependent; Tracheostomy; Non-invasive positive pressure mechanicalventilation; Non-invasive sequential downgrade therapy

CLC：

DOI：

10.12114/j.issn.1008-5971.2022.00.094

Funds：

河南省医学科技攻关计划项目（201702193）；河南省医学教育研究课题（wjlx2019079）；河南省人民医院2021新业务新技术项目（2112342122）

摘要：

目的 探讨无创序贯降级治疗在气管切开呼吸机依赖患者中的应用效果。方法 选取2019年8月至2021年2月河南省人民医院RICU中气管切开呼吸机依赖患者68例。由呼吸治疗师实施无创序贯降级治疗。观察无创序贯降级治疗前(T0)、无创序贯降级治疗后2 h(T1)、无创序贯降级治疗后24 h(T2)时患者的生命体征(心率、呼吸频率、收缩压、舒张压)、血气分析指标[动脉血氧饱和度(Sa O2)、p H值、动脉血二氧化碳分压(Pa CO2)、动脉血氧分压(PaO2)]、痰液黏稠度及转归情况。结果 4例患者因个人原因退出本研究,最终纳入64例患者。T1时心率、呼吸频率高于T0时(P<0.05)。T2时心率低于T1时(P<0.05)。T1时PaCO2高于T0时,PaO2低于T0时(P<0.05)。T2时PaO2高于T1时(P<0.05)。无创序贯降级治疗前后痰液黏稠度比较,差异无统计学意义(P>0.05)。19例患者撤机并拔出气切套管,占29.7%;18例患者撤机成功转为经气管切开处加温湿化氧疗,占28.1%;10例患者白天经气管切开处氧疗,夜间佩戴无创正压呼吸机,占15.6%;11例患者自购无创正压呼吸机,在普通病房、康复医院及家庭之间实施无创序贯降级治疗,占17.2%;6例患者因感染加重转为有创机械通气,占9.4%,其中4例患者死亡,占6.3%。随访截止时,未发生不良事件和不耐受现象。结论 无创序贯降级治疗可作为气管切开呼吸机依赖患者的一种替代治疗方案。

Abstract：

【Abstract】　Objective To explore the application effect of non-invasive sequential downgrade therapy in tracheostomyventilator-dependent patients. Methods A total of 68 tracheostomy-ventilator-dependent patients in RICU of Henan ProvincialPeople's Hospital from August 2019 to February 2021 were selected. Non-invasive sequential downgrade therapy was administeredby a respiratory therapist. The vital signs (heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure) , blood gasanalysis indexes [oxygen saturation in arterial blood (SaO2) , pH value, partial pressure of carbon dioxide in arterial blood (PaCO2) ,partial pressure of oxygen in arterial blood (PaO2) ] , sputum viscosity at the time that before non-invasive sequential downgrade therapy(T0) , 2 h after non-invasive downgrade therapy (T1) and 24 h after non-invasive downgrade therapy (T2) and the outcome of patientswere observed.Results The heart rate and respiratory rate of T1 were higher than those of T0 ( P < 0.05) . The heart rate of T2 waslower than that of T1 (P < 0.05) . The PaCO2 of T1 was higher than that of T0, and the PaO2 of T1 was lower than that of T0 (P < 0.05) .The PaO2 of T2 was higher than that of T1 (P< 0.05) . There was no significant difference in sputum viscosity before and after noninvasive sequential downgrade therapy (P ＞0.05) . Nineteen patients were weaned from the ventilator and pulled out the tracheostomytube, accounting for 29.7%. Eighteen patients were weaned successfully and switched to warm humidified oxygen therapy throughtracheostomy, accounting for 28.1%. Eleven patients purchased non-invasive positive pressure ventilator by themselves, andimplemented invasive-non-invasive mechanical ventilation downgrade therapy between general wards, rehabilitation hospitalsand families, accounting for 17.2%. Six patients were converted to invasive mechanical ventilation due to aggravation of infection,accounting for 9.4%. Four patients dead, accounting for 6.3%. At the end of follow-up, there were no adverse events or intolerance.Conclusion The non-invasive sequential downgrade therapy can be used as a safe alternative for tracheostomy-ventilatordependent patients.

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