无创正压通气在呼吸衰竭合并左心衰竭患者有创机械通气撤机中的应用

Clinical application of noninvasive positive pressure ventilation after removal of endotracheal intubation in respiratory failure combining left heart failure patients

目的观察无创正压通气对COPD呼吸衰竭合并冠心病左心衰竭患者有创机械通气撤机成功率及患者死亡率的影响。方法选用2009年至2013年因COPD呼吸衰竭合并左心衰竭行有创机械通气患者45例,其中24例拔管后行无创通气,21例拔管后常规氧疗,比较两组撤机成功率、病死率。结果无创通气组23人成功撤机,撤机成功率95.8%;氧疗组14人成功撤机,撤机成功率66.7%;两组撤机成功率的比较差异有统计学意义(χ2检验值4.27,P<0.05)。无创通气组死亡1人,死亡率4.2%,氧疗组死亡5人,死亡率23.8%。两组患者死亡率比较差异无统计学意义(χ2检验值2.233,P>0.05)。结论无创正压通气可提高COPD呼吸衰竭合并冠心病左心衰竭患者有创机械通气的撤机成功率。

Objective To determine whether noninvasive positive pressure ventilation（NPPV） reduces mortality and improves successful extuhation from mechanical ventilation in respiratory failure for chronic obstructive pulmonary disease（COPD） combining left heart failure for coronary heart disease. Methods The study group included 45 patients with respiratory failure for COPD combining left heart failure for coronary heart disease, divided into an NPPV group（24 patients）and an control group （21 patients）, after Spontaneous breathing trials ,the endotracheal intubation was removal ,the NPPV group was followed by immediate application of NPPV and the control group received oxygen therapy. Results Totally 23 patients in the NPPV group were extubated successfully whereas 14 patients in the control group. The rate of successful extubation was higher in the NPPV groups than the eontroI group （95. 8% vs. 66. 7%, P 〈 0. 05 ）. The in - hospital mortality rate was similar between the NPPV group and the control group （4. 2%vs. 23. 8% ,P 〉0. 05）. Condusion NPPV effectively improve successful extubation in respiratory failure for COPD combining left heart failure for coronary heart disease.