无创正压通气应用于胸外科术后临床效果分析

Clinical effect analysis of noninvasive positive pressure ventilation after thoracic surgery

①目的探讨无创正压通气(Noninvasivepositive pressure ventilation,NPPV)改善胸外科术后患者肺功能及其辅助治疗的临床效果分析。②方法选取2017年11月~2018年10月我科收治的80例术后成功脱离气管插管有创通气的患者,根据治疗方案分为观察组(40例)和对照组(40例)。对照组接受常规综合治疗(抗感染、镇痛、氧疗、引流、营养支持治疗等),观察组在对照组的基础上加用NPPV术后持续8小时。分别统计患者术后无创通气前(T1)、无创通气1h后(T2)及无创通气8小时后(T3)的血气分析等情况;并观察对比两组患者术后1个月及术后3个月的相关肺功能指标。以此评估术后应用NPPV和常规综合治疗的临床效果差异。③结果与对照组相比,观察组患者的氧分压(PaO2)及二氧化碳分压(PaCO2),在术后给予NPPV辅助治疗后的不同时间点(T2、T3)比较,差异均有统计学意义(P<0.05);对两组患者的PaO2及PaCO2进行重复测量的方差分析,PaO2不同时间点与组别交互检验,说明不同组别PaO2随着时间点推进的趋势有显著差异,具有统计学意义(Partial Eta Squared=0.696、F=87.937、P<0.05);PaCO2不同时间点与组别交互检验,说明不同组别PaCO2随着时间点推进的趋势有显著差异,具有统计学意义(Partial Eta Squared=0.943、F=631.268、P<0.05)。FEV1%、DLCO%值在术后第1个月的时间点差异存在统计学意义(P<0.05),在术后第3个月的时间点差异均不存在统计学意义(P>0.05)。④结论无创正压通气应用于胸外科术后患者,在一定程度上可以改善术后患者早期肺功能。

Objective To explore the clinical effect of noninvasive positive pressure ventilation (NPPV) in improving lung function and adjuvant therapy in patients afteRthoracic surgery.Methods Cases were selected from 80 patients who underwent successful intubation and intubation in ouRdepartment from NovembeR2017 to OctobeR2018.The patients were divided into observation group (40 cases) and control group(40 cases).The control group received routine comprehensive treatment (anti-infective,analgesic,oxygen therapy,drainage,nutritional support treatment,etc.),and the observation group was given NPPV foR8 hours on the basis of the control group.The blood gas analysis (PaO 2,PaCO 2) of patients before and afteRnon-invasive ventilation (T1),non-invasive ventilation (T2) and non-invasive ventilation foR8 hours (T3) were compared,and the two groups were observed foR1 month afteRoperation.The relevant lung function indexes at 3 months afteRsurgery,percentage of forced expiratory volume in 1st second (FEV1%),and diffuse function of lung as a percentage of predicted value (DLCO%).This was used to assess the difference in clinical outcomes between postoperative NPPV and conventional combination therapy.Results Compared with the control group,PaO 2 and PaCO 2 in the observation group had different( P < 0.05 ) at different time points (T2, T3) afteRadjuvant treatment with NPPV,and were statistically significant;PaO 2 and PaCO 2 were analyzed by repeated measures of variance.PaO 2 interaction time and group were tested at different time points and groups.(Partial Eta Squared=0.696, F =87.937, P < 0.05 ),indicating that the trend of PaO 2 in different groups was higheRwith time.Significantly different, statistically significant;PaCO 2 interaction test with different time points and groups(Partial Eta Squared=0.943, F =631.268, P < 0.05 ),indicating that there was a significant difference in the trend of PaCO 2 in different groups with time,statistically significant.The difference of FEV1% and DLCO% values at the first month afteRoperation,it was statistically significant( P < 0.05 ),and there was no statistical difference at the time point of the third month afteRoperation( P > 0.05 ).Conclusion Non-invasive ventilatoRused in patients afteRthoracic surgery can improve the early lung function of patients afteRsurgery.