无创机械通气在肺癌呼吸衰竭患者中的应用

Noninvasive mechanical ventilation as treatment of acute respiratory failure in patients with lung cancer

目的探讨评价应用无创机械通气对肺癌患者急性呼吸衰竭(呼衰)进行通气支持的意义和效果。方法我科2007年1月至2010年4月接受无创机械通气的肺癌患者急性呼吸衰竭病例26例,同期未行机械通气的30例急性呼吸衰竭肺癌患者设为对照组;无创机械通气以经面罩压力支持通气+呼气末正压通气(PSV+PEEP),上机前及上机后2h分别采动脉血气分析,用自身对照方法,采用t检验,比较无创机械通气前后呼吸频率动脉血气分析结果,并记录机械通气时间,最终结果,统计一周死亡率;对照组统计一周死亡率。结果无创机械通气后PaO2显著升高,氧合指数改善(P<0.05,PaCO2虽有下降,但差异无统计学意义(P>0.05),7例成功撤机,19例死亡,最短上机时间7h,最长8d,一周死亡率76.92%。对照组一周死亡率100%(P<0.05。结论应用无创机械通气对肺癌急性呼衰患者进行呼吸支持,是一项有价值的措施,部分患者可获得生存延长。

Objective To investigate the clinical effect of non-invasive mechanical ventilation（NIV）on acute respiratory failure in patients with lung cancer.Methods The clinical data of patients with lung cancer and who were affected by severe hypoxic or hypercapnic acute respiratory failure in Department of Respiratory Medicine of Tianjin Port Hospital from January 2005 to April 2010 were collected.26 patients accepted noninvasive mechanical ventilation.The same period of 30 patients who only receive oxygen therapy were set as control group.Arterial blood gas analysis,and oxygenation index（PaO2/FiO2）before and 2 hours after NIV,7-day mortality were analyzed and compared between two groups.Results After 2 hour,NIV was significantly improved PaO2/FiO2（P〈0.05）.Seven of 26 patients were successfully ventilated and discharged alive,while 19/26 patients（73.08%）died before the seventh day.29/30 patients（96.6%）died before the seventh day in control group（P〈0.05）.Conclusion Patients with lung cancer and ＂reversible＂ acute respiratory failure are likely to benefit from NIV.NIV may improve survival in some patients.