心脏外科术后呼吸功能不全的无创正压通气治疗

Treatment of respiratory insufficiency after cardiac surgery with noninvasive positive pressure ventilation

目的探讨心脏术后无创通气治疗的效果、安全性以及对术后恢复的影响。方法 2005年12月-2009年12月心脏手术429例,按照是否行无创通气治疗分为研究组(N组,n=28)和对照组(C组,n=401)。分别在无创正压通气治疗前24h、16h、8h和治疗后8h、16h、24h、48h记录患者的生命体征指标和血气结果。比较两组术后监护室停留时间、并发症和住院时间。结果 N组吸烟患者75.0%(21)明显高于C组47.5%(190)平均NPPV治疗时间为(40.8±15.4)h,NPPV治疗后呼吸次数、动脉血pH值、氧分压、心率和血氧饱和度改善明显,有效率92.8%;对于肺部感染所致呼吸功能不全疗效相对较差。结论无创通气治疗能够改善心脏术后拔管困难患者的肺功能,减少再次插管。

Objective To study the effect and safety of noninvasive positive pressure ventilation （NPPV） on respiratory insufficiency after cardiac surgery. Methods Four hundred and twenty-nine patients who underwent cardiac surgery in December 2005 - December 2009 were divided into treatment group（n=28） and control group（n=401）. Their life symptoms and artery blood gas were recorded 24, 16, and 8h before, and 8, 16, 24 and 48h after NPPV. ICU stay time, complications and hospital stay time of the two groups were compared after operation. Results The efficiency of NPPV on respiratory insufficiency was higher in smokers of treatment group than in those of control group （75.0% vs 47.5%, P〈0.05）. The average NPPV time was 40.8 ± 15.4h. The respiratory rate, arterial blood pH value, partial pressure of oxygen, heart rate and blood oxygen saturation were significantly improved after NPPV （P〈0.05） with an effective rate of 92.8%. The efficiency of NPPV on respiratory insufficiency caused by pulmonary infection was relatively poor. Conclusion NPPV can improve the lung function of patients with respiratory insufficiency after cardiac surgery, thus avoiding a second intubation.