无创正压通气在小儿先天性心脏病术后的应用  

The application Of noninvasive positive pressure ventilation in children with congenital heart disease after operation

作　　者：杨维君[1] 何小军[1] 

机构地区：[1]浙江大学附属儿童医院外科监护室,浙江杭州310003

出　　处：《杭州师范学院学报（医学版）》2008年第3期159-161,170,共4页Journal of Hangzhou Teachers College :Medical Edition

摘　　要：目的评价无创正压通气(NPPV)治疗小儿先天性心脏病术后呼吸衰竭的价值。方法回顾2006年1月至2007年12月,先天性心脏病行体外循环心内直视手术1 402例,拔除气管插管后因不同程度的呼吸衰竭需再次机械通气47例,首选无创正压通气支持(NPPV组)22例,气管内置管行有创机械通气支持(CMV组)25例。结果成功脱离机械通气NPPV组77.3%(17/22)、CMV组76.0%(19/27),差异无显著统计学意义;两组机械通气支持时间分别为7-54 h(32.65±18.23 h)、32-498(120.15±98.34 h),监护时间2-10 d(4.5±3.4 d)、4-35(19.3±15.4 d),差异均有显著统计学意义。机械通气前及之后2 h、4 h患儿的氧合指数两组无显著统计学意义,而机械通气后0.5 h氧合指数两组存在显著统计学差异。结论临床应用NPPV可避免一部分先心病术后出现呼吸衰竭的患儿再次气管插管,并减少呼吸系统的并发症;但临床症状无改善或出现循环不稳定者,因NPPV改善氧合较慢,应尽早气管插管予有创机械通气支持。Objective To evaluate the clinical effects of noninvasive positive pressure ventilation （NPPV） on treating respiratory failure in children patients after cardiac operation in surgical intensive care unit （SICU）. Methods 1 402 children patients undergoing cardiac operations for congenital heart diseases （CHD） from Jan 2006 to Feb 2007 were enrolled in this study. 47 cases developed respiratory failure after extubation postoperatively. 22 cases were treated with noninvasive positive pressure ventilation （ the group NPPV） , and 25 children were treated with conventional mechanical ventilation（the group CMV）. Results The number of successful extubation was 17/22（77.3% ） in the NPPV group and 19/25 （76%） in the CMV group. There was no significant difference between these two groups. Mechanical ventilation time and the monitoring time in ICU was 7 - 54 h （ 32.65 ± 18.23 h） and 2 - 10 d （4.5 ± 3.4 d） respectively in the group NPPV, which were significantly shorter than those in the group CMV [32 -498 （ 120.15 ±98.34 h） and 4 -35 （ 19.3 ± 15.4 d） , respectively]. Oxygen index was lower in the NPPV group than that in the CMV group at 0.5 h after mechanical ventilation, whereas, there were no significant differences between these two groups before mechanical ventilation and at 2 or 4 hours after mechanical ventilation. Conclusion These results suggest NPPV be a beneficial method which can avoid re-intubation in patients with postoperative respiratory failure after extubation and reduce lung complications. If there was either no improvement in clinical symptoms or heart failure, conventional mechanical ventilation support should be given as soon as possible because NPPV improves insufficient oxygenation more slowly.

关 键 词：先天性心脏病 机械通气 无创通气 

分 类 号：R654[医药卫生—外科学]