摘要目的:探讨高流量氧疗对创伤性连枷胸机械通气患者拔管后临床疗效的影响。方法:回顾分析2016年10月至2019年12月上海长征医院急救科ICU病房收治的创伤性连枷胸并接受机械通气的患者80例作为研究对象，按照有无使用高流量氧疗分为经鼻高流量氧疗(高流量)组与传统流量氧疗组(传统流量组)。分析高流量氧疗对该类患者氧合指数、脱离呼吸机时间、再插管率、ICU停留时间、呼吸机相关性肺炎(VAP)及在ICU病死率的影响。结果:高流量组患者到达切换点时间为(4.6±2.1)d，传统流量组到达切换点的时间为(4.3±2.2)d，差异无统计学意义( P>0.05)。到达切换点时，2组患者动脉血的pH、PaO 2、PaCO 2等通气氧合指标以及心率(HR)、平均动脉压(MAP)等比较差异无统计学意义( P>0.05)。高流量组拔管后2 h，氧合指数PaO 2/FiO 2、PaCO 2较传统流量组显著改善，再次插管患者的比率显著低于传统流量组，患者脱离呼吸机的时间明显延长，ICU停留时间显著缩短，VAP发生率显著降低，差异均有统计学意义( P<0.05)。 结论:经鼻高流量氧疗有助于创伤性连枷胸接受机械通气患者更早地脱离机械通气，并降低VAP的发生率，可临床推广应用。

abstractsObjective:To explore the clinical effects of high flow nasal cannula (HighFlow) on patients with traumatic flail chest after removing mechanical ventilation.Methods:A retrospective analysis was carried out on 80 traumatic flail chest patients with mechanical ventilation, admitted to the ICU of Department of Emergency and Critical Care Medicine of Shanghai Changzheng Hospital from October 2016 to December 2019, who were divided into the HighFlow group and the conventional oxygen therapy (COT) group. The clinical effects of high flow nasal cannula on PaO 2/FiO 2 ratio, ventilation-free days, re-intubation case number, length of stay in ICU, incidence of ventilation associated pneumonia (VAP), and ICU mortality were analyzed. Results:The time point of extubation of the HighFlow group was (4.6±2.1) d, while that of the COT group was (4.3±2.2) d ( P>0.05). At the time point of extubation, the differences of the ventilation oxygenation indexes, i. e. arterial blood gas pH, PaO 2, and PaCO 2, heart rate (HR), and mean arterial pressure (MAP), between the two groups were not statistically significant ( P>0.05). PaO 2/FiO 2 and PaCO 2 at 2 h after extubation in the HighFlow group were significantly improved as compared with in the COT group; the re-intubation rate of the HighFlow group was significantly lower than that of the COT group; the time of ventilation-free of the HighFlow group was significantly longer than that of the COT group; the length of stay in ICU of the HighFlow group was significantly shorter than that of the COT group; the incidence of VAP of the HighFlow group was obviously lower than that of the COT group; all differences were statistically significant ( P<0.05). Conclusion:For traumatic flail chest patients with mechanical ventilation, high flow oxygen therapy can help them wean from mechanical ventilation earlier and reduce the incidence of VAP, which is worthy of popularization and application in clinic.