无创正压通气治疗心脏术后并发急性呼吸功能衰竭的护理

Nursing of Patients Undergoing Non-invasive Bi-level Positive Airway Pressure for Respiratory Failure following Cardiac Surgery

目的探讨无创双水平呼吸道正压通气(bilevel positive airway pressure,BIPAP)模式对体外循环心脏手术后并发急性呼吸功能衰竭的疗效。方法对20例心脏术后并发急性呼吸功能衰竭患者采用BIPAP呼吸机进行通气,准确记录通气前及通气后2、6、24 h心率、血压、呼吸频率及动脉血气的变化。结果除2例患者因排痰不畅,导致二氧化碳潴留需重新置管行机械通气外,其余18例患者治疗期间至撤机后pH值变化不明显,呼吸及循环功能等指标均明显改善,和治疗前比较有统计学意义(P<0.05或P<0.01),患者病情明显好转。结论合理应用无创双水平呼吸道正压通气可以迅速改善心脏术后并发急性呼吸功能衰竭患者的通气功能,有利于纠正呼吸功能衰竭,且对循环功能影响小,可作为再次插管前的补救措施之一。

Objective To discuss the effect of non-invasive bi-level positive airway pressure（BIPAP） ventilation for treatment of acute respiratory failure following cardiac surgery with cardiopulmonary bypass. Methods Twenty patients who developed acute respiratory failure after cardiac surgery on cardiopulmonary bypass received non-invasive P1PAP ventilation, and their heart rate, blood pressure, respiratory rate and arterial blood gas changes were precisely recorded before and 2, 6, 24 h after ventilation. Results Except for two cases in which tracheal intubation was performed due to carbon dioxide retention resulting from expectoration difficulty, all the patients showed no significant changes in the pH value and significant improvement in respiratory and circulatory functions after withdrawal of ventilation（ P 〈0.05 or P 〈0.01）. The symptoms of the patients were obviously alleviated. Conclusion Adequate application of non-invasive BIPAP ventilation can rapidly improving the ventilation function of the patients who develop acute respiratory failure after cardiac surgery, and help correct respiratory failure without seriously affecting the circulatory function. It can be used as a means for avoiding a second tracheal intubation.