双水平气道正压无创通气用于老年患者全麻恢复期的呼吸支持

A clinical study on Bi-level positive airway pressure ventilation in the elderly during emergence

目的研究双水平气道正压(BiPAP)通气在老年患者全麻恢复期呼吸支持的可行性。方法30例择期手术的老年患者随机分为BiPAP组与对照组,每组15例。在术前、拔管后、吸氧或无创通气1h后三个时点比较血液动力学、动脉血气分析参数和呼吸动力学指标。结果两组患者血液动力学的各项指标在各时点差异无显著意义;BiPAP组无创通气1h后PaCO2较拔管后降低,与对照组吸氧1h后比PaCO2低;拔管后两组患者PaO2较术前降低,BiPAP组吸氧1h可提高PaO2。BiPAP无创通气1h后,VTi、VE、Cdyn升高,RAWm降低;而对照组吸氧1h后较拔管后无明显改善。结论老年患者短期BiPAP面罩支持无创通气耐受性好,对血液动力学无明显影响,可以改善通气和氧合,降低气道阻力,提高肺顺应性。

Objective To study the clinical application of Bi-level positive airway pressure （BiPAP） ventilation in elderly patients during anesthesia recovery period. Methods Thirty elderly patients underwent selective operation were divided into control group（n ： 15）and BiPAP group（n： 15）. The hemodynamic parameters, arterial blood gas analysis and the pulmonary dynamics parameters were recorded and compared with those of preoperation,after extubation, and after receiving O2 via facial mask or BiPAP ventilation for 1 h. Results There was no marked difference among three points in hemodynamic parameters between two groups. In BiPAP group ,PaCO2 decreased after ventilation for one hour compared with that during extubation period and the PaCO2 was lower than that in control group. In both groups,PaO2 decreased after extubation. In BiPAP group , PaO2 increased after ventilation for one hour compared with that during extubation period, which was higher than that in control group. After BiPAP ventilation for 1 h,VT~ ,VE ,Cdyn increased and RAWm decreased to the level of preoperation. In control group , VTi, VE, Cdyn , RAWm did not changed significantly. Conclusion The elderly patients tolerate BiPAP ventilation for short time with facial mask well, with less influence on the hemodynamics ,improved ventilation and oxygenation, decreased airway pressure, and increased pulmonary compliance.