使用双水平气道正压通气无创呼吸机进行有创机械通气的临床研究

Clinical analysis of invasive mechanical ventilation with bilevel positive airway pressure non-invasive ventilator

目的探讨使用双水平气道正压通气(BiPAP)无创呼吸机对需长期辅助机械通气的患者进行有创机械通气的可行性。方法选择2004年6月～2007年11月因呼吸衰竭入住呼吸ICU,经面罩机械通气等方法撤机失败或不能进行面罩机械通气的11例患者,给予气管切开,更换BiPAP无创呼吸机行有创机械通气,观察改用无创呼吸机前后动脉血气、住院时间、出院(或达到出院标准)后存活时间等指标。结果无创通气吸气压力设定为16～26cmH2O,平均21.3cmH2O,呼气压力4cmH2O,呼吸频率16次/min。患者的平均住院(或达到出院标准)时间为(91.5±50.2)d,改为BiPAP呼吸机后平均住院(或达到出院标准)时间为(23.5±12.2)d。出院(或达到出院标准)后平均存活时间为(353.1±296.5)d,截至随访结束(2008年1月13日)有4例患者仍存活。BiPAP呼吸机使用前后动脉血pH、PaCO2、PaO2及SaO2均无显著差异(P均>0.05)。结论对于临床稳定、仍需长期机械通气的呼吸衰竭患者,使用BiPAP无创呼吸机通过气管切开行有创机械通气是可选择的方法。

Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU） of our department,who needed prolonged mechanical ventilation,between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data,length of stay（LOS）,LOS after changing to BiPAP non-invasive ventilator,survival time after discharge（or fulfilled the discharge standards） were reviewed retrospectively.Results The settings of inspiratory pressure,expiratory pressure and respiratory rate of non-invasive ventilation were 21.3（16-26） cm H2O,4 cm H2O,and 16 min-1,respectively.The LOS（or up to the discharge standard） was（91.5±50.2） days.The LOS（or up to the discharge standard） after changing to BiPAP ventilator was（23.5±12.2） days.The mean survival time after discharge（or up to the discharge standard） was（353.1±296.5） days.Four patients were still alive up to the end of the study.The arterial pH,PaCO2,PaO2,and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.