无创正压通气序贯治疗急性左心衰合并呼吸衰竭患者的时机选择

Opportunity of Noninvasive Positive Pressure Ventilation Sequential Treatment for Patients with Acute Left Heart Failure Combined with Respiratory Failure

目的:探讨无创正压通气序贯治疗急性左心衰合并呼吸衰竭患者的时机选择。方法:选择2013年6月-2015年8月我院收治的120例先行气管插管有创通气治疗的急性左心衰合并呼吸衰竭患者作为研究对象,病情得到控制后,按照拔管时间的长短分为A、B、C 3组,各40例,其中A组在进行自主呼吸30 min后拔管,B组在进行自主呼吸2 h后拔管,C组在进行自主呼吸24 h后拔管,拔管后全部患者均进行无创正压通气序贯治疗,比较3组患者治疗后血气分析结果、呼吸机相关肺炎发生率及脱机成功率。结果:13组患者无创正压通气治疗后的呼吸频率、心率、氧合指数、氧分压、二氧化碳分压及ph值均无明显差异(t1=1.402,t2=1.338,t1=0.738,t2=1.201,t1=0.969,t1=0.857,均P>0.05);2A组患者的脱机成功率为7.50%,显著低于B组的77.50%与C组的82.50%,差异具有统计学意义(P<0.05);A组患者的再插管率为92.50%,显著高于B组的22.50%与C组的17.50%,比较差异具有统计学意义(P<0.05);A组患者的呼吸机相关肺炎发生率为45.00%,显著高于B组的12.50%与C组的10.00%,比较差异具有统计学意义(P<0.05)。结论:急性左心衰合并呼吸衰竭患者在自主呼吸超过2 h后拔管,进行无创正压通气序贯治疗,可明显提高脱机成功率,降低再插管率和呼吸机相关肺炎发生率,值得临床推广。

Objective： To explore the opportunity of noninvasive positive pressure ventilation sequential treatment for patients with acute left heart failure combined with respiratory failure. Methods： Selected 120 cases of patients with acute left heart failure complicated with respiratory failure in our hospital from June 2013 to August 2015 as the objects,after the illness were controled, all patients were divided into three groups of A, B, C groups and with 40 patients in each group according to the time of pulled out the pipe, the pipe of A group was pulled out 30 min after spontaneous breathing, B group was after 2 h, while C group was after 24 h, and all patients were treated with noninvasive positive pressure ventilation sequential, the blood gas analysis, the occurrence of ventilator associated pneumonia and the success rate of off-line in the 3 groups were compared. Results：1Respiratory rate, heart rate, oxygen index, oxygen pressure,oxygen partial pressure, carbon dioxide pressure and p H value in the 3 groups of patients were not significantly different（t1=1.402, t2=1.338, t3=0.738, t4=1.201, t5=0.969, t6=0.857 P〉0.0）; 2Offline success rate of the A group was 7.50%, which was significantly lower than77.50% of the B group and 82.50% of the C group, the differences were statistically significant（P 0.05）. The reintubation rate of the A group was 92.50%, which was significantly higher than 22.50% of the B group and 17.50% of the C group, the differences were statistically significant（P〈0.05）. The ventilator associated pneumonia incidence of the A group was 45.00%, which was significantly higher than12.50% of the B group and 10.00% of the C group, the differences were statistically significant（P〈0.05）. Conclusions： Using non-invasive positive pressure ventilation sequential treatment for patients with acute left heart failure combined with respiratory failure after extubation of more than 2 h is able to significantly improve the success rate of weaning, reduce the reintubation rate,and the incidence of ventilator associated pneumonia, which is worthy of clinical promotion.