高流量湿化氧疗联合气管切开在老年脑出血病人中的应用效果及肺部感染的危险因素分析

doi:10.3969/j.issn.1005-6483.20241598

摘要/Abstract

摘要： 目的探讨高流量湿化氧疗联合气管切开在老年脑出血病人中的应用效果，分析肺部感染危险因素。方法 2019年～2023年气管切开的脑出血老年病人140例，根据给氧方式分为两组:观察组93例，行高流量湿化氧疗;对照组47例，行普通低流量吸氧治疗。比较两组氧分压（PaO₂）、血氧饱和度（SpO₂）、心率、平均动脉压变化。根据观察组病人住院期间有无出现肺部感染分为感染组（26例）与非感染组（67例），分析影响老年脑出血病人住院期间并发肺部感染的危险因素，构建列线图预测模型预测并发肺部感染风险。结果观察组治疗24、72小时PaO₂、SpO₂均高于对照组，呼吸频率低于对照组，差异有统计学意义（P＜0.05）。观察组痰液黏稠度（Ⅰ度痰68例、Ⅱ度痰25例）改善情况优于对照组（Ⅰ度痰16例、Ⅱ度痰17例、Ⅲ度痰14例），观察组痰痂形成率为0，吸痰次数为每天（5.15±1.08）次，对照组分别为14.87%和每天（8.17±1.82）次，两组比较差异有统计学意义（P＜0.05）。感染组与非感染组气管切开时间、吸烟史、卧床时间、机械通气时间、鼻饲管留置时间等比较中，差异有统计学意义（P＜0.05）。Logistic回归分析显示，气管切开时间＞5天、吸烟史、卧床时间＞10天、机械通气时间≥24小时、鼻饲管留置时间≥10天是影响老年脑出血病人治疗期间并发肺部感染的危险因素（P＜0.05）。列线图预测模型预测老年脑出血病人治疗期间并发肺部感染的AUC、敏感度、特异度分别0.696、0.565、0.889。结论高流量湿化氧疗联合气管切开在老年脑出血病人中有利于改善氧合状态，但气管切开时间、吸烟史、卧床时间、机械通气时间、鼻饲管留置时间会对病人治疗期间并发肺部感染产生影响，依据这些危险因素构建列线图模型对评估并发肺部感染具有较高的预测效能。

关键词: 高流量湿化氧疗, 气管切开, 老年, 脑出血, 肺部感染

Abstract: Objective To investigate the application effect of high flow humidified oxygen therapy combined with tracheotomy in elderly patients with cerebral hemorrhage and analyze the risk factors of pulmonary infection.Methods A total of 140 elderly patients with cerebral hemorrhage who underwent tracheotomy in our hospital from 2019 to 2023 were selected as the study objects,of which 93 patients receiving high-flow humidified oxygen therapy were selected as the observation group,and 47 patients receiving conventional low-flow oxygen therapy were selected as the control group during the same period.The changes of PaO₂,SpO₂,heart rate and mean arterial pressure were compared,and patients in the observation group were divided into infected group (n=26) and non-infected group (n=67) according to whether pulmonary infection occurred during hospitalization.The risk factors affecting pulmonary infection during hospitalization in elderly patients with cerebral hemorrhage were analyzed,and a nematographic prediction model was built to predict the risk of pulmonary infection.Results The PaO₂ and SpO₂ levels in observation group were higher than those in control group at 24h and 72 h,but the respiratory rate was lower than that in control group (P<0.05).The improvement of sputum viscosity in the observation group (68 cases of grade Ⅰ sputum and 25 cases of grade Ⅱ sputum) was better than that in the control group (16 cases of grade Ⅰ sputum,17 cases of grade Ⅱ sputum and 14 cases of grade Ⅲ sputum).The rate of phlegm scab formation (0) and the number of sputum aspiration (5.15±1.08) times were lower than those in the control group [14.87%,(8.17±1.82) times] (P<0.05).There were significant differences in tracheotomy time,smoking history,bed rest time,mechanical ventilation time and nasal feeding tube retention time between infected and non-infected groups (P<0.05).Logistic regression analysis showed that tracheotomy time > 5d,smoking history,bed time > 10d,mechanical ventilation time ≥24h,nasal feeding tube retention time ≥10d were the risk factors for pulmonary infection in elderly patients with cerebral hemorrhage during treatment (P<0.05).The AUC,sensitivity and specificity were 0.696,0.565 and 0.889 in elderly patients with cerebral hemorrhage complicated by pulmonary infection during treatment.Conclusion High-flow humidification oxygen therapy combined with tracheotomy can improve the oxygenation status in elderly patients with cerebral hemorrhage,but the time of tracheotomy,smoking history,bed rest time,mechanical ventilation time,and nasal feeding tube retention time will affect the pulmonary infection during treatment.The construction of a nomogram model based on these risk factors has higher predictive efficacy in evaluating the pulmonary infection.

Key words: high flow humidified oxygen therapy, tracheotomy, elderly, cerebral hemorrhage, pulmonary infection

侯自明刘东远杨俊侯哲王浩张洪兵. 高流量湿化氧疗联合气管切开在老年脑出血病人中的应用效果及肺部感染的危险因素分析[J]. 临床外科杂志, 2025, 33(7): 697-.

HOU Ziming, LIU Dongyuan, YANG Jun, HOU Zhe, WANG Hao, ZHANG Hongbing. Application effect of high flow humidified oxygen therapy combined with tracheotomy in elderly patients with cerebral hemorrhage and analysis of risk factors for pulmonary infection[J]. JOURNAL OF CLINICAL SURGERY, 2025, 33(7): 697-.

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