急性左心衰合并Ⅱ型呼吸衰竭患者的NIPPV序贯治疗时机探讨

Investigation on the timing of noninvasive positive pressure ventilation as sequential therapy in the treatment of patients with acute left heart failure complicating type Ⅱ respiratory failure

目的探讨有创通气治疗急性左心衰合并Ⅱ型呼吸衰竭患者采用无创正压通气(NIPPV)序贯治疗的时机。方法选取本院2012年12月至2014年12月收治的92例先行气管插管有创通气治疗的急性左心衰竭合并Ⅱ型呼吸衰竭患者为研究对象,所有患者按自主呼吸试验的时间长短分为三组,A组30例在自主呼吸试验时间30 min拔管,B组31例在2 h后拔管,C组31例在24 h后进行拔管。所有患者均在拔管后开始NIPPV序贯治疗,观察比较不同时间点NIPPV序贯治疗后的脱机成功率、呼吸机相关肺炎(VAP)发生率和血气分析结果。结果三组患者脱机成功率分别为10.00%、80.65%、83.87%,B组和C组脱机成功率明显高于A组,差异均有统计学意义(P<0.05),而B组和C组相似,差异无统计学意义(P>0.05);A组患者VAP发生率为43.33%,明显高于B组的12.90%、C组的9.68%,差异均有统计学意义(P<0.05);血气分析结果发现,三组患者接受无创通气后的p H值、氧分压、二氧化碳分压、氧合指数、心率、呼吸频率与拔管时比较差异均无统计学意义(P>0.05)。结论自主呼吸试验时间>2 h时,呼吸衰竭患者可拔管予以NIPPV序贯治疗,其脱机成功率高,且可降低48 h再插管率,值得临床推广。

Objective To investigate the timing of noninvasive positive pressure ventilation （NIPPV） as se-quential therapy during invasive ventilation for patients with acute left heart failure complicating typeⅡrespiratory failure. Methods Ninety-two patients who underwent invasive ventilation for acute left ventricular failure complicat-ed with typeⅡrespiratory failure from December 2012 to December 2014 in our hospital were enrolled in the study. According to the time of spontaneous breathing trial, the patients were divided into three groups：group A （30 cases, underwent extubation 30 min after spontaneous breathing trial）, group B （31 cases, underwent extubation 2 h after spontaneous breathing trial）, group C （31 cases, underwent extubation 24 h after spontaneous breathing trial）. All pa-tients received NIPPV after extubation as sequential therapy. The success rate of weaning from the ventilator, the inci-dence of ventilator associated pneumonia （VAP）, blood gas analysis results were compared at different time points af-ter NIPPV. Results The success rate of weaning from the ventilator were 10.00%, 80.65%, 83.87%in group A, B, C, respectively. The rates in group B and group C were significantly higher than that in group A （P〈0.05）, while the rates in group B and C showed no statistically significant difference （P＆gt;0.05）. The incidence of VAP was 43.33%in group A, significantly higher than 12.90%in group B and 9.68%in group C （P〈0.05）. Blood gas analysis showed that there was no statistically significant difference in all the three groups in pH value, the partial pressure of oxygen, partial pressure of carbon dioxide, oxygenation index, heart rate, respiratory rate between after NIPPV and at extubation （P〉0.05）. Conclusion For patients with acute left heart failure complicating typeⅡrespiratory failure, when spontane-ous breathing keeps over 2 hours, extubation can be made and NIPPV sequential therapy can started, which will lead to a higher successful rate of weaning from ventilator without increase of re-intubation rate within 48 hours.