无创通气改善心脏术后呼吸功能不全患者心功能的效果

Effect of noninvasive mechanical ventilation on cardiac function after the heart surgery

目的观察无创通气对心脏术后患者血流动力学的影响。方法对心脏术后在气管插管拔除后出现呼吸功能不全的患者48例实施无创通气治疗。记录无创通气前(T0)、无创通气30min(T1)、1h(T2)、2h(T3)、4h(T4)的脉搏氧饱和度(SpO2)、氧合指数(OI)、平均动脉压(MAP)、心率(HR)、中心静脉压(CVP)、心指数(CI)、右心射血分数(RVEF)、右室舒张末容积(RVEDV)、平均肺动脉压(MPAP)、肺血管阻力指数(PVRI)。结果与T0比较,HR、MAP、CVP、RVEDV在T1、T2、T3、T4时均无明显变化(P>0.05);MPAP在T4时明显降低(P<0.05);PVRI在T3、T4时明显降低(P<0.05);CI、RVEF在T3、T4时明显升高(P<0.05);SpO2和OI在T2、T3、T4时明显上升(P<0.05)。结论心脏术后出现呼吸功能不全时进行无创通气治疗可明显改善心功能。

Objective To investigate the effects of noninvasive mechanical ventilation on hemodynamics after heart surgery.Methods Noninvasive mechanical ventilation was performed in 48 patients underwent cardiosurgery with respiratory insufficiency after extubation.The pulsed oxygen saturation（SpO2）,oxygenation index（OI）,mean arterial pressure（MAP）,heart rate（HR）,central venous pressure（CVP）,cardiac index（CI）,right ventricular ejection fraction（RVEF）,right ventricular end-diastolic volume（RVEDV）,mean pulmonary artery pressure（MPAP） and pulmonary vascular resistance index（PVRI） were recorded after extubation（T0）,at 30 min（T1）,60 min（T2）,120 min（T3） and 240 min（T4） during noninvasive mechanical ventilation.Results Compared with T0,there were no remarkable changes of HR,MAP,CVP and RVEDV at T1,T2,T3 and T4（P0.05）,but CI and RVEF were highly increased at T3 and T4（P0.05）,MPAP was decreased at T4（P0.05）,PVRI was decreased at T3 and T4（P0.05）,and SpO2 and OI were highly increased at T2,T3 and T4（P0.05）.Conclusion The noninvasive mechanical ventilation can effectively improve cardiac function in the patients underwent heartsurgery with respiratory insufficiency after extubation.