无创正压通气对非气管插管麻醉患者围术期输血相关性急性肺损伤治疗的安全性

Safety of Non Invasive Positive Pressure Ventilation in Patients with Non Tracheal Intubation Anesthesia for Perioperative Blood Transfusion-related Acute Lung Injury

目的:探讨无创正压通气(non invasive positive pressure ventilation,NIPPV)对非气管插管麻醉患者围术期输血相关性急性肺损伤(transfusion-related acute lung injury,TRALI)治疗的安全性。方法:选取本院2014年1月-2017年5月接收的60例输血相关性急性肺损伤患者作为此次研究对象,按照随机数字表法分为对照组与试验组,各30例。入院后均给予常规系统治疗,对照组给予高流量面罩吸氧,试验组采用NIPPV进行治疗。观察并比较两组患者不同时间段血气分析、生理指标、预后及用药安全。结果:两组患者的p H在各个时间段内对比,差异均无统计学意义(P>0.05);在经过不同方式的吸氧后,两组Pa CO_2、Pa O_2/Fi O_2水平在通气2、48 h后以及脱机后24 h均较通气前有明显改善,且试验组通气48 h后以及脱机后24 h Pa CO_2、Pa O_2/Fi O_2水平均明显低于对照组,差异均有统计学意义(P<0.05)。两组患者的Sp O_2与MAP在各个时间段内对比,差异均无统计学意义(P>0.05);通气前两组患者HR、RR对比,差异均无统计学意义(P>0.05);在经过不同方式的吸氧后,两组HR、RR水平在通气2、48 h后均较通气前有明显改善,且试验组HR、RR水平均明显优于对照组,差异均有统计学意义(P<0.05)。两组患者躁动、嗜睡以及缺氧发生率对比,差异均无统计学意义(P>0.05);但试验组患者进展ARDS以及死亡率均明显低于对照组,差异均有统计学意义(P<0.05)。结论:无创正压通气对非气管插管麻醉患者围术期输血相关性急性肺损伤疗效显著,改善血气分析指标,稳定其生命体征,减少术后肺部并发症,对其预后至关重要,值得在临床推广使用。

Objective：To investigate the safety of non invasive positive pressure ventilation（NIPPV） in the perioperative period of transfusion-related acute lung injury（TRALI） in patients undergoing non tracheal intubation anesthesia.Method：In our hospital from January 2014 to May 2017,60 cases of transfusion-related acute lung injury were selected as the research objects,they were randomly divided into control group and experimental group,30 cases in each group.All were given routine treatment after admission,the control group was given high flow oxygen mask,the experimental group was treated by NIPPV.The blood gas analysis,physiological indexes,prognosis and drug safety of the two groups were observed and compared.Result：There were no significant differences in the difference of p H between the two groups in each time period（P〈0.05）;after inhaling oxygen in different ways,the Pa CO2,Pa O2/Fi O2 levels in the two groups were significantly improved at 2 h and 48 h after ventilation and 24 h after weaning,compared with those before ventilation,the levels of Pa CO2,Pa O2/Fi O2 in the experimental group were significantly lower than those in the control group after 48 h ventilation and 24 h after weaning,the differences were statistically significant（P〈0.05）.There were no significant differences in the difference of Sp O2 and MAP between the two groups in each time period（P〈0.05）;there were no significant differences in HR and RR between the two groups before ventilation（P〈0.05）,after inhaling oxygen in different ways,the HR and RR in the two groups were significantly improved after 2 h and 48 h of ventilation compared with those before ventilation,and the HR and RR in the experimental group were significantly higher than those in the control group,the differences were statistically significant（P〈0.05）.The incidence of restlessness,lethargy and anoxia were not significantly different between the two groups（P〈0.05）;but the ARDS and mortality in the experimental group were significantly lower than those in the control group（P〈0.05）.Conclusion：Noninvasive positive pressure ventilation has significant effect on perioperative transfusion related acute lung injury in non tracheal intubation patients, improving blood gas analysis index, stabilizing vital signs, reducing postoperative pulmonary complications,and is very important for prognosis,it is worth popularizing in clinic.