无创通气联合鼻咽通气管在脑卒中患者中的应用研究

Application of noninvasive ventilation with nasopharyngeal airway in .stroke patients

目的研究无创通气联合鼻咽通气管在脑卒中意识障碍患者中的临床应用价值。方法对2011年5月至2013年5月泰州市人民医院ICU收治的脑卒中后无创通气患者155例进行治疗分析，其中男88例、女67例，年龄30～95岁、平均73岁，APACHE1／评分5，13分、Glasgow评分7—13分。其中鼻咽通气管组78例，对照组口咽通气管组77例。临床观察指标观察两组患者放置通气管前无创通气（TO）、放置通气管后无创通气10min（T10）、20min（T20）30min（T30）的SBP、DBP、HR、Sp02、PCO2，记录两组气管插管率、肺部感染发生率。结果口咽通气管组在放置口咽通气管无创通气30min后PaO2、PCO：均有改善；SBP、DBP、HR均有所下降，可能是因为呼吸状态改善以后，应激状态下降，继而循环有所改善。而放置鼻咽通气管无创通气30min后呼吸状态改善效果更好与放置口咽通气管无创通气10min、20min、30min后相比，PaO2、PCO2、SBP、DBP、HR均得到更好地改善（P〈0．05），口咽通气管组患者气管插管31例（40．3％）、肺部感染19例（24．7%），鼻咽通气管组分别为15例（19．2％）、11例（14．1％），两组气管插管、肺部感染及住ICU时间比较，均P〈0．05。结论放置鼻咽通气管后无创通气可有效改善脑卒中患者的通气功能障碍，改善缺氧、二氧化碳蓄积，并通过有效吸痰减少肺部感染与气管插管率。提示放置鼻咽通气管后无创通气是解决脑卒中患者上呼吸道阻塞开丌’效通气的方法。

Objective To study the employment of noninvasive ventilation with nasopharyngeal airway in coma patients with cerebral stroke. Methods One hundred and fifty -five stroke patients treated with noninvasive ventilation admitted from May 2011 to May 2013 were studied. There were 88 male and 67 female, aged 30 - 95 years with mean age 73 years, The patients suffered from stroke with APACHE 11 score 5 - 13 and Glasgow coma score 7 - 13. There were 78 cases in the nasopharyngeal airway group, and 77 cases in oropharyngeal airway group as control. SBP, DBP, HR, SpO2 and PCO2 were observed in the two groups at the time of beginning of noninvasive ventilation with neither airway （ T0）, and after placement of either airway and noninvasive ventilation for 10 min （ T10 ） , 20min （ T20 ） , and 30 min （ T30 ） , respectively. The differences in rate of endotracheal intubation and the incidence of pulmonary infection were compared between the two groups. Results PaO2, SBP, PCO2 were improved after 30 minutes of noninvasive ventilation in the oropharyngeal airway group, and SBP DBP, HR decreased which were associated with improved respiration, less stress response, and then good blood circulation system. The better improvement of respiration was observed in nasopharyngeal airway group after 30 minutes of noninvasive ventilation. More improvements in PaO2, PCO2, SBP, DBP, HR were observed 30 minutes after noninvasive ventilation with nasopharyngeal airway c6mpared with control group （ P 〈 0.05 ）. The endotracheal intubation was used in 31 cases （40. 3%） in the oropharyngeal airway group, and among them, 19 cases （24.7%） suffered pulmonary infection. But there were 15 cases （19.2%） with endotracheal intubation in the nasopharyngeal airway group and 11 cases （14. 1%） with pulmonary infection. The length of ICU stay, incidence of endotracheal intubation, and rate of pulmonary infection were lower in nasopharyngeal airway group （P 〈 0. 05 ）. Conclusions The nasopharyngeal airway used in noninvasive ventilation can effectively ameliorate ventilation dysfunction in stroke patients, correct hypoxia and lessen accumulation of carbon dioxide, also reduce the pulmonary infection and the rate of endotracheal intubation. Nasopharyngeal airway used in noninvasive ventilation is a effective modality to solve upper airway obstruction and offer effective ventilation in stroke patients.