无创正压通气治疗急性Stanford B型主动脉夹层合并低氧血症的疗效观察

Efficacy observation of non-invasive positive pressure ventilation treating hypoxemia secondary to acute Stanford type B aortic dissection

目的:探讨无创正压通气(NPPV)治疗急性Stanford B型主动脉夹层合并低氧血症的临床应用价值。方法:入选2017年9月至2019年9月,在我院治疗的急性Stanford B型主动脉夹层合并低氧血症的98例。随机分为NPPV组(行无创正压通气氧疗,n=48)和高流量吸氧组(行经鼻高流量吸氧氧疗,n=50)。治疗后比较两组患者氧合指数(PaO2/FiO2)、氧疗时间、ICU治疗时间。结果:氧疗12 h后,两组患者的PaO2/FiO2均明显改善(P<0.05)。与高流量吸氧组比较,NPPV组24 h后低氧血症明显改善[PaO2/FiO2:(207.6±15.4)vs.(172.2±14.7),P<0.001],氧疗时间[(34.2±5.5)vs.(53.4±6.8)h,P<0.001]和ICU治疗时间[(50.5±10.2)vs.(72.2±13.2)h,P<0.001]也显著减少。结论:与经鼻高流量吸氧比较,NPPV可较快改善急性Stanford B型主动脉夹层并发的低氧血症,促进肺功能恢复,值得临床推广应用。

Objective:To explore the clinical application value of non-invasive positive pressure venti-lation in the treatment of hypoxemia secondary to acute Stanford type B aortic dissection.Methods:The 98 pa-tients with acute Stanford type B aortic dissection with hypoxemia in our hospital from September 2017 to Sep-tember 2019 were selected.They were randomly divided into the NPPV group(receiving noninvasive positive pressure ventilation,n=48)and the high-flow oxygen inhalation group(receiving nasal high-flow oxygen thera-py,n=50).After treatment,the oxygenation index(PaO2/FiO2),oxygen therapy time and ICU treatment time were compared between the two groups.Results:After 12 hours of oxygen therapy,PaO2/FiO2 of the two groups were significantly improved(P<0.05).Compared with the high-flow oxygen inhalation group,the hy-poxemia in the NPPV group was significantly improved after 24 hours[PaO2/FiO2:(207.6±15.4)vs.(172.2±14.7),P<0.001],and the oxygen therapy time[(34.2±5.5)vs.(53.4±6.8)h,P<0.001]and ICU treat-ment time[(50.5±10.2)vs.(72.2±13.2)h,P<0.001]were also significantly reduced.Conclusions:Com-pared with nasal high-flow oxygen inhalation,the NPPV can quickly improve the hypoxemia complicated by a-cute Stanford type B aortic dissection and promote the recovery of lung function.the NPPV is worthy of clinical application for the hypoxemia complicated by acute Stanford type B aortic dissection.