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