摘要
目的：探讨冠状动脉旁路移植术（CABG）后延迟拔管患者采用有创-无创序贯性机械通气的效果及护理方法。方法：将40例CABG后超过8h仍不能拔管患者随机分为序贯治疗组和对照组各20例，序贯治疗组拔除气管内导管，采用无创呼吸机行鼻面罩双水平正压通气；对照组在达到无创通气标准后仍按常规继续行气管内插管机械通气。结果：序贯治疗组有创、总机械通气时间及ICU停留时间、ICU期间费用均低于对照组（P〈0．05），而呼吸机相关性肺炎（VAP）发生率与对照组比较差异无统计学意义（P〉0．05）。结论：对CABG后延迟拔管患者采用有创-无创序贯性机械通气治疗，可缩短机械通气时间，且积极有效的护理措施是有创-无创序贯性机械通气治疗成功的关键。
Objective： To explore the effect of invasive and non - invasive sequential mechanical ventilation and nursing methods applied to the patients with delayed extubation after coronary artery bypass grafting （ CABG）. Methods： 40 patients with delayed extubation over 8 hours after CABG were randomly divided into sequential treatment group and control group （ 20 cases for each group ）. Bi - level positive airway pressure ventilation with nasal mask was provided for the patients by non - invasive ventilator when the endotracheal tube was removed in the sequential treatment group; Conventional endotracheal intubation mechanical ventilation continued to be used when non - invasive ventilation reached standards in the control group. Results： The time of invasive ventilation, the total duration of mechanical ventilation and the time of patientg stay in ICU was shorter and ICU costs were lower in the sequential treatment group than those in the control group （ P 〈 0. 05 ） ; no statistically significant difference was found in the comparison of the incidence of ventilator - associated pneumonia （ VAP ） between the two groups （ P 〉 0. 05）. Conclusion ： The invasive and non - invasive sequential mechanical ventilation can shorten the duration of mechanical ventilation for the patients with delayed extubation after CABG and effective nursing measures are very important to ensure the success of the treatment by invasive and non - invasive sequential mechanical ventilation.
