无创正压通气在老年患者全身麻醉术后的应用

Use of noninvasive positive pressure ventilation in the prevention and treament of pulmonary complication in aged patients after general anesthesia and operation

目的研究无创正压通气在老年患者全身麻醉术后肺部并发症的预防和治疗作用。方法将术前情况基本相同的60例全身麻醉术后的老年患者随机分为无创正压通气治疗组和对照组,治疗组为拔管后即应用无创正压通气,持续24小时,其它处理与对照组相同。观察术前、拔管时、拔管后0.5小时、2小时、8小时、24小时、48小时监测动脉血气、心率及呼吸频率;比较术前、拔管后、24小时、48小时X胸片;术前、拔管后0.5小时、2小时、8小时、24小时、48小时肺活量;拔管后0.5小时、2小时、8小时、24小时、48小时疼痛视觉模拟评分值。观察肺部感染发生率、住院天数及不良反应。结果两组患者术后都出现了低氧血症和高碳酸血症,6.67%患者发生肺不张。经过24小时无创正压通气治疗后,治疗组的动脉血气指标、肺活量和肺不张情况较对照组得到明显的改善(P<0.05),无创正压通气对术后疼痛有一定的缓解作用(P<0.05)。结论无创正压通气对老年患者全身麻醉术后的低氧血症、高碳酸血症和肺不张有较好的防治作用。

Objective To determine the effect of noninvasive positive pressure ventilation on the prevention and treatment of pulmonary complication in aged patients after general anesthesia and operation. Methods 60 aged patients who have comparable baseline conditions were randomly divided into trial group and control group. Arterial blood gases were monitored in all patients at preoperation, and 0,0.5,2,8,24,48h after extubation. Chest radiograph and vital capacity were compared at preoperation, and 0, 24,48h after extubation, the incidence of pulmonary infection, hospital day and adverse effect were observed simultaneously. Results Hypoxemia and hypercapnia were found in both groups,atelectasis was observed in some patients. Outcome measuring of arterial blood gas and vital capacity in trial group was better than those of control group significantly, atelectasis was significantly improved （ P〈0.05）, the postoperative pain relieved partly by noninvasive positive pressure ventilation（ P〈0.05）. Conclusions Noninvasive positive pressure ventilation have preventive and therapeutic effect on hypoxemia,hypercapnia and atelectasis for aged patient after general anesthesia and operation, and more observations are needed.