无创头罩持续气道内正压通气治疗心脏术后低氧血症

Helmet delivered continuous positive airway pressure for hypoxemia treatment in airway extubated patients after cardiac surgery

目的评价无创头罩持续气道内正压通气治疗心脏术后低氧血症的有效性和安全性。方法2014年3月至2015年7月期间心脏外科危重症中心收治的心脏术后拔除气管插管48h内出现低氧血症且氧合指数〈200的成年患者120例。其中男80例，女40例；年龄37～82岁，平均（61．9±8．2）岁。中心随机法分为头罩持续气道内正压通气组（研究组）和面罩高浓度氧疗组（对照组），各60例，疗程6h。收集人组患者临床资料，记录入组前即刻、治疗3h和6h的动脉血气分析结果、生命体征、超声心动结果等；记录ICU滞留时间、住院日、机械通气使用和30天内死亡；观察并发症和评价耐受性。通过组间对照和自身对照比较各项参数。结果与对照组比较，研究组氧合指数升高（144．35±24．43对201．35±52．97，P〈0．05）；左心室射血分数升高（0．5383±0．0844对0．5540±0．0844，P〈0．05）；呼吸频率[（22．60±5．08）次／min对（18．53±4．13）次／min，P〈0．05]和休克指数（0．85±0．35对0．75±0．15，P〈0．05）降低；机械通气被迫使用率及ICU滞留时间明显少于对照组[6．67％对28．33％，41．0（25．0，67．5）h对49．5（32．5，90．8）h，P〈0．05]，未发生明显不良事件。结论无创头罩持续气道内正压通气可安全用于心脏术后低氧血症患者，有效提高氧合指数，改善心功能，减少ICU滞留时间和机械通气被迫使用率。

Objective To evaluate the efficacy and safety of helmet delivered continuous positive airway pressure （ Hel- met-CPAP）for hypoxemia in airway extubated patients after cardiac surgery. Methods 120 adult patients in ICU from March 2014 to July 2015, who were after cardiac surgery, were enrolled. These patients who suffered hypoxemia within 48 hours after extubation, defined as that PaO2/FiO2 with oxygen mask could not reach 200, were divided into two groups. In the control group high concentration oxygen therapy with mask was delivered, while helmet-CPAP was delivered in the experimental group. Treatment duration was 6 hours. Results Helmet-CPAP significantly improved PaO2/FiO2 （ 144.35 ± 24.43 vs. 201.35 ± 52.97, P 〈 0.05 ） and left ventricular ejection fractions（0. 5383 ± 0. 0844 vs. 0. 5540 ± 0. 0844, P 〈 0.05 ）. Breathing rate （22.60 ±5.08 vs. 18.53 ±4.13, P 〈0.05）, heart rate（ 102.72 ± 17.9 vs. 95.15 ± 13.79, P 〈0.05） and shock index （0.85 ± 0. 35 vs. 0.75 ± 0.15, P 〈 0.05 ）were significantly lower. The rate of using mechanical ventilation （6.67% vs. 28. 33 % , P 〈 0.05 ） and length of ICU stay [ 41.0 （ 25.0,67.5 ） hours vs. 49.5 （ 32.5,90.8 ） hours, P 〈 0.05 ] was significantly less than control group. Conclusion Helmet delivered continuous positive airway pressure is an effective and safe treatment for hypoxemia in airway extubated patients after cardiac surgery.