无创正压通气辅助内科胸腔镜检查在胸腔积液合并呼吸衰竭患者中的应用探讨

Application of medical thoracoscopy assisted by non-invasive positive pressure ventilation in patients with pleural effusion and respiratory failure

目的探讨在无创正压通气辅助下对胸腔积液合并呼吸衰竭患者行胸腔镜检查的安全性及有效性。方法选取52例胸腔积液合并呼吸衰竭需要行内科胸腔镜检查的患者,随机分为无创通气组(26例)和普通吸氧组(26例)。术前、术中至术后2 h监测患者生命体征及血气分析、氧合指数情况。评估患者操作相关并发症。结果无创通气组患者均能顺利完成胸腔镜检查,术中生命体征平稳,氧合指数由术前(214.65±37.99)mmHg升至术中(242.85±26.34)mmHg,PaCO2水平轻度下降。普通吸氧组中有2例患者操作过程中因血氧饱和度下降需终止操作,转换为无创通气支持后,血氧饱和度上升,能够顺利完成操作。其余24例患者操作过程中心率、血压及呼吸频率增加,术中PaO2及氧合指数下降,PaCO2水平轻度增高。2组患者诊断率方面差异无统计学意义。2组均无严重操作相关并发症。结论无创通气辅助下对胸腔积液合并呼吸衰竭患者行内科胸腔镜检查,是安全、有效的。

Objective To discuss the safety and validity of medical thoracoscopy assisted by non-invasive positive pressure ventilation in patients with pleural effusion and respiratory failure.Methods 52 patients with pleural effusion complicated with respiratory failure who needed medical thoracoscopy were selected and randomly divided into non-invasive positive pressure ventilation group(n=26)and oxygen group(n=26).Vital signs,blood gas analysis and oxygenation index were monitored before,during and two hours after operation.Operation related complications were evaluated.Results 26 patients in non-invasive positive pressure ventilation group were able to complete the thoracoscopy successfully.The vital signs were stable during the operation.The oxygenation index increased from(214.65±37.99)mmHg(preoperation)to(242.85±26.34)mmHg(during the operation).Two patients in the oxygen group had to transfer to non-invasive ventilation due to the decrease of oxygen saturation during the operation.After that,the oxygen saturation recovered and the operation could be completed successfully.In the other 24 patients,the heart rate,blood pressure and respiratory rate increased,PaO2 and oxygenation index decreased,and PaCO2 increased slightly.There was no difference in the diagnosis rate between the two groups.There were no serious operation related complications in both groups.Conclusions Non-invasive positive pressure ventilation assisted medical thoracoscopy is safe and effective for patients with pleural effusion and respiratory failure.