摘要
目的:临床回顾性研究无创正压通气(NPPV)在体外循环术后出现急性呼吸衰竭患者中应用的安全性和有效性。方法:回顾2010-01至08我院在全麻体外循环下行心脏手术的患者(年龄>16岁)450例,术后全部顺利拔管,其中24例拔管后出现急性呼吸衰竭给予NPPV治疗,为NPPV组;拔管后未出现急性呼吸衰竭的患者426例为对照组。比较NPPV治疗前、治疗后1 h的氧分压/吸入气体氧含量(PaO2/FiO2)、心率、呼吸次数和动脉血酸碱度(pH),并用患者围手术期的临床特征作为参数来分析NPPV失败的预测因素。结果:NPPV治疗平均(12.33±11.97)h,NPPV治疗后1 h与治疗前比较,PaO2/FiO2明显升高,呼吸次数、心率明显减低(P均<0.01),差异均有统计学意义。所有患者均无NPPV相关并发症。NPPV失败的相关危险因素包括:NPPV治疗后1 h的PaO2/FiO2<200(P=0.043)、第一次机械通气时间(P=0.039)和肺炎(P<0.0001),其中肺炎是NPPV失败的独立相关危险因素(比值比16.000;95%可信区间1.996～128.289)。结论:体外循环术后患者拔管后出现急性呼吸衰竭,NPPV可以有效改善肺部氧合,减低再次气管插管的需要,但要根据病因选择病例。
Objective ：To study the safety and efficacy of noninvasive positive-pressure ventilation（NPPV） in patients with acute respiratory failure（ARF） after cardiopulmonary bypass（CPB） surgery. Methods：We retrospectively analyzed 450 patients（ age〉16 years）who underwent cardiac surgery with CPB from January to August 2010 in our hospital. There were 24 patients with ARF after the procedure who treated by NPPV as NPPV group, the rest 426 patients without ARF were defined as Control group. The PaO2/FiO2 ratio, heart rate and respiratory rate were compared before and 1 hour after NPPV procedure respectively. The peri-operative characteristics were evaluated as predictors for NPPV failure in clinical practice. Results ： The mean length of NPPV support was （ 12. 33± 11.97 ） hours. Compared with the baseline, at 1 hour after treatment, the patients had increase PaO2/FiO2 ratio, decreased heart and respiratory rate, P〈O. O1 respectively. No patients suffered from NPPV complication. The related risk factors for NPPV failure including PaO2/FiO2 ratio〈200 at 1 hour after the treatment, P = 0. 043, duration of initial mechanical ventilation ,P= 0. 039, and pneumonia,P〈0. 0001. Pneumonia was the independent risk factor for NPPV failure（ OR 16. 000;95% CI 1. 996 - 128. 289）. Conclusion：NPPV could effectively improve the PaO2/FiO2 ratio, and may decrease the re-intubation rate in patients with ARF after CPB. While the treatment should be individualized according to different causes.
出处
《中国循环杂志》
CSCD
北大核心
2012年第3期212-215,共4页
Chinese Circulation Journal
关键词
无创正压通气
急性呼吸衰竭
体外循环
肺炎
Noninvasive positive pressure ventilation
Acute respiratory failure
Cardiopulmonary bypass
Pneumonia
