无创正压通气在外科术后发生急性呼衰患者中过渡撤机的临床48例分析

Clinical analysis of NPPV in treatment ARF after surgery

目的比较无创正压通气(NPPV)和有创正压通气(IPPV)救治外科术后发生急性呼吸衰竭(ARF)的临床效果,评估NPPV在治疗中(过渡撤机)的作用。方法对48例外科术后发生ARF的患者先采用气管插管IPPV治疗72h后不能撤机者进行NPPV以过渡撤机,观察比较IPPV72h后与NPPV12h后两者HrBPR及动脉血气分析各指标。结果IPPV72h后与NPPV12h后,各指标HrBPRPaO2PaCO2均稳定,差异无显著性(P>0.05)48例中,39例成功撤机,9例因并发心、脑、血液系统疾病重新气管插管或气管切开进行IPPV。结论在经过选择的外科术后发生ARF患者中经气管插管IPPV治疗72h后难以撤机者,实施NPPV以过渡撤机,可达到理想的通气支持治疗效果。

Objective To compare the clinical efficacy of noninvasive posittve pressure Ventilation （NPPV）and invasive positive pressure ventilation （ IPPV ） in patients of acute respiratory failure （ARF） after surgery and evaluate the effect of NPPV for removing mechanical ventional as a transition period on the treatment of ARF. Methods 48 patients with ARF after surgery were treated by NPPV after they couldn＇t separate themselves from mechanical vcntional by IPPV 72 h with endotrachenal intubation, conditions including Hr. Bp. R and arterial blood gases parameters incluiding pH. PaO2. SaO2. PaCO2 were obserrod. Results By comparing both conditions and blood gases parameters were steady after IPPV 72 h and NPPV 12 h, the differences were not statistically significant （P 〉 0. 05 ）. 39 eases were succeed, there were 9 cases with complication of cardiac and haematolagy and cerebrorascular diseases who needed treacha eannula again or tracheotomy. Conclusion Use of NPPV in selected patients with ARF after surgery has a satisfactory thempeutic effect of the ventilatory support after failing to remove mechanical ventional by IPPV 72 h with tracheal intubation.