标题：高压氧联合舱内呼吸机治疗在呼吸机脱机困难患者中的应用

      作者：许季祥 1，2，魏翔 1，周小妹 1，齐胤良 1    1.合肥市第二人民医院(安徽医科大学附属合肥医院)高压氧科，安徽 合肥 230011；2.蚌埠医学院附属合肥市第二人民医院，安徽 蚌埠 233000

      卷次： 2023年34卷4期

      【摘要】 目的 探讨高压氧联合舱内呼吸机治疗在呼吸机脱机困难患者中的应用效果。方法 回顾性分析2018年1月1日至2020年12月31日合肥市第二人民医院高压氧科收治的30例脱机困难患者的临床资料。所有患者均给予高压氧联合舱内呼吸机治疗，分析其脱机情况，比较患者治疗前后的血气指标、心功能指标、甲状腺功能指标和格拉斯哥昏迷评分(GCS)。结果 30例脱机困难患者中共有22例脱机成功，且脱机成功患者高压氧联合舱内呼吸机治疗次数主要集中在1~5次；治疗后的动脉血氧分压(PaO2)、血氧饱和度(SaO2)、氧合指数(OI)、格拉斯哥昏迷评分(GCS)评分分别为(82.17±9.93) mmHg、(97.80±2.66)%、(391.27±47.31) mmHg、(10.00±1.82)分，明显高于治疗前的(58.60±7.88) mmHg、(85.77±3.60)%、(279.05±37.53) mmHg、(6.37±1.87)分，差异均有统计学意义(P<0.05)；治疗后，患者左室射血分数(LVEF)、每搏输出量(SV)分别为 (63.20±4.85)%、(86.43±6.73) mL，较治疗前的 (48.10±3.40)%、(71.33±8.11) mL明显升高，而左心室收缩末期容积(LVESV)、左心室的舒张末期容积(LVEDV)分别为(114.70±9.91) mL、(178.33±14.66) mL，较治疗前的(145.50±5.65) mL、(223.13±14.23) mL明显下降，差异均有统计学意义(P<0.05)；治疗后，患者甲状腺功能指标甲状腺素(T4)、三碘甲状原氨酸(T3)、游离三碘甲状腺素(FT3)、游离甲状腺素(FT4)和促甲状腺激素(TSH)分别为(5.95±0.99) μg/dL、(1.82±0.40) pmol/L、(2.79±0.91) pmol/L、(20.21±4.39) pmol/L、(2.06±1.04) mU/L，明显高于治疗前的(4.05±0.76) μg/dL、(1.51±0.31) pmol/L、(1.55±0.37) pmol/L、(9.28±1.29) pmol/L、(0.73±0.71) mU/L，差异均有统计学意义(P<0.05)。结论 高压氧联合舱内呼吸机对脱机困难者的脱机效果十分显著，能提高患者血气功能、心功能、甲状腺功能以及改善患者昏迷意识状态。
      【关键词】 高压氧；舱内呼吸机；脱机；血气指标；心功能指标；甲状腺功能指标
      【中图分类号】 R459.6 【文献标识码】 A 【文章编号】 1003—6350（2023）04—0501—05

Application of hyperbaric oxygen combined with in-cabin ventilator therapy in patients with difficulty inweaning from the ventilators.
XU Ji-xiang 1,2, WEI Xiang 1, ZHOU Xiao-mei 1, QI Yin-liang 1. 1. Department ofHyperbaric Oxygen, the Second People's Hospital of Hefei (Hefei Hospital Affiliated to Anhui Medical University), Hefei230011, Anhui, CHINA; 2. Hefei Second People's Hospital Affiliated to Bengbu Medical College, Bengbu 233000, Anhui,CHINA
【Abstract】 Objective To investigate the application effect of hyperbaric oxygen combined with in-cabin venti-lator therapy in patients with difficulty in weaning from the ventilators. Methods The clinical data of 30 patients withdifficulty in weaning from the ventilators admitted to the Department of Hyperbaric Oxygen, the Second People's Hospi-tal of Hefei from January 1, 2018 to December 31, 2020 were retrospectively analyzed. All patients were given the hyper-baric oxygen combined with in-cabin ventilator therapy, and the difficulty in weaning situation was analyzed. Bloodgas index, cardiac function index, thyroid function index, and Glasgow Coma Scale (GCS) were compared before andafter treatment. Results A total of 22 of 30 patients with difficulty in weaning were successfully treated, and the num-ber of hyperbaric oxygen combined with in-cabin ventilator therapy for patients in successful weaning from the venti-lators was mainly concentrated in 1-5 times. The scores of arterial partial pressure of oxygen (PaO2), oxygen satura-tion (SaO2), oxygenation index (OI), and Glasgow Coma Score (GCS) after treatment were (82.17 ± 9.93) mmHg,(97.80±2.66)% , (391.27±47.31) mmHg, and (10.00±1.82) points, respectively, which were significantly higher than(58.60±7.88) mmHg, (85.77±3.60)%, (279.05±37.53) mmHg, and (6.37±1.87) points before treatment (P<0.05). Aftertreatment, the left ventricular ejection fraction (LVEF) and stroke output (SV) were (63.20±4.85)% and (86.43±6.73) mL,respectively, which were significantly higher than (48.10±3.40)% and (71.33±8.11) mL before treatment, and the leftventricular end-systolic volume (LVESV) and left ventricular end-diastolic volume (LVEDV) were (114.70±9.91) mLand (178.33±14.66) mL, significantly lower than (145.50±5.65) mL and (223.13±14.23) mL before treatment (P<0.05).After treatment, the thyroid function indexes including thyroxine (T4), triiodothyronine (T3), free triiodothyronine(FT3), free thyroxine (FT4), and thyroid stimulating hormone (TSH) were (5.95±0.99) μg/dL, (1.82±0.40) pmol/L,(2.79 ± 0.91) pmol/L, (20.21 ± 4.39) pmol/L, (2.06 ± 1.04) mU/L, respectively, which were significantly higher than(4.05±0.76) μg/dL, (1.51±0.31) pmol/L, (1.55±0.37) pmol/L, (9.28±1.29) pmol/L, and (0.73±0.71) mU/L before treat-ment (P<0.05). Conclusion Hyperbaric oxygen combined with in-cabin ventilator has a significant effect on the pa-tients difficulty in weaning from the ventilators, which can improve the blood gas function, cardiac function, thyroidfunction and improve the coma consciousness.
      【Key words】 Hyperbaric oxygen; In-cabin ventilator; Weaning; Blood gas index; Cardiac function index; Thy-roid function index