有创与无创序贯机械通气治疗在心脏外科术后的应用

Application of sequential non - invasive ventilation following invasive mechanical ventilation in patients after cardiac surgery

目的 探讨有创与无创序贯机械通气治疗在心脏外科术后ICU中的应用效果.方法 选取44例接受心脏外科手术的患者,术后均存在一定程度的脱机困难,将其分为两组：序贯治疗组,23例患者,常规治疗的基础上,以同步间歇指令通气方式行机械通气,待患者呼吸循环状态稳定后拔除气管插管,改双水平气道正压（BiPAP）支持通气方式并撤机;对照组,21例患者,以同步间歇指令通气＋压力支持通气方式撤机.对照分析两组病例的通气、氧合指标、有创机械通气时间和总的机械通气时间,并发症发生率.结果 序贯治疗组和对照组患者有创机械通气时间分别是（2.3±0.8）d和（7.3±0.5）d,总机械通气时间分别是（4.2±0.5）d和（7.3±0.5）d,住ICU时间分别为（6.5±0.9）d和（10.3±0.4）d,呼吸机相关肺炎分别为6例（26.1%）和12例（57.1%）,两组患者中,治疗组有2例患者二次插管（8.7%）,而对照组有3例患者二次插管（14.3%）.结论 心脏外科术后患者,如果存在脱机困难,可采用早期拔管,改用经鼻面罩呼吸机正压通气以缩短机械通气时间,减少呼吸机相关肺炎的发生.

Objective To estimate the feasibility and efficacy of sequential non - invasive mechanical ventilation following invasive mechanical ventilation in the patients after cardiac surgery. Methods A total of 44 patients who underwent cardiac operation and were difficult in weaning ventilator were divided into two groups. All patients received routine drug therapy and endotracheal intubation. Twenty - three patients in sequential therapy group were ventilated by sequential invasive and non - invasire mechanical ventilation. The other twenty - one patients received invasive mechanical ventilation therapy. Results The time for invasive mechanical ventilation were（ 2.3 ± 0.8 ） and （ 7.3 ± 0.5 ） days in sequential therapy and control group （ P 〈 0.05 ）. Total mechanical ventilation time were （ 4.2 ± 0.5 ） and （7.3 ± 0.5 ） days respectively（ P 〈 0.05 ）. The stay in ICU time were （ 6.5 ± 0.9 ） and （ 10.3 ± 0.4 ） days. The incidence of mechanical ventilation - related pneumonia were 6/23 and 12/21. There was no death in both groups. Conclusion Sequential non - invasive ventilation following invasive mechanical ventilation can shorten the mechanical ventilation time and reduce the incidence of mechanical ventilation -related pneumonia in the patients after cardiac surgery.