冠状动脉旁路移植术后撤机困难的序贯通气治疗  

Invasive-noninvasive sequential ventilation for extubation failure after coronary artery bypass surgery

作　　者：程智广[1] 杨传瑞[1] 李大连[1] 郭建中[1] 高翔[1] 杨峰[1] 

机构地区：[1]首都医科大学附属北京友谊医院心脏中心,北京100050

出　　处：《第三军医大学学报》2010年第12期1357-1359,共3页Journal of Third Military Medical University

摘　　要：目的探讨冠状动脉旁路移植术后撤机困难应用有创-无创序贯通气治疗的有效性。方法 2005年12月至2010年2月我院行冠状动脉旁路移植术患者360例,21例出现撤机困难而行无创通气治疗,设为研究组(N组,n=21),余为对照组(C组,n=339)。分别在术前、治疗前8h、治疗即刻、治疗后8、16、24、48h7个时间点观察呼吸次数、动脉血气指标、心率、肺动脉压、氧合指数及肺泡-动脉氧分压差等指标的变化。结果研究组高龄(>65岁)、近期吸烟、氧合指数低、肌酐清除率低、3支血管病变及合并瓣膜病变比例高于对照组(P<0.05)。研究组术中搭桥数量≥3支较多、输血量较大,转机比例较高(P<0.05)。无创通气治疗后呼吸次数、动脉血气指标、心率、肺动脉压、氧合指数及肺泡-动脉氧分压差显著改善(P<0.05),无创通气对于心源性肺水肿、肺不张和急性肺损伤所致撤机困难改善明显,而对于肺部感染所致撤机困难疗效不理想,2例中行再次插管1例,总有效率95.2%。结论冠状动脉旁路移植术后撤机困难患者应用有创-无创序贯通气治疗,能够改善氧合,尽早拔管。Objective To assess the validity of non-invasive positive pressure ventilation in correcting impediments to weaning from mechanical ventilation in those patients who failed to be extubated after coronary artery bypass surgery. Methods Three hundred and sixty patients undergoing coronary artery bypass surgery during December 2005 to February 2010 were included in the study. Those patients were divided into non-invasive positive pressure ventilation group due to extubation failure （N group,n=21） and control group （C group,n=329）. During non-invasive positive pressure ventilation,mean arterial pressure,heart rate,respiratory rate,arterial pH value,arterial oxygen saturation,pulmonary arterial pressure,arterial oxygen tension,oxygen/inspired oxygen fraction ratio and alveolar-arterial oxygen tension difference were measured at preoperative,8 and 0 h before noninvasive positive-pressure ventilation,and 8,16,24 and 48 h after ventilation. Results Elder age （older than 65 years）,current smoking,low arterial oxygen tension /fraction of inspired oxygen,low endogenous creatinine clearance rate,with 3 vessels involved and associated valvular disease may be the risk factors of extubation failure （P0.05）. The percentages of more than 3 grafts,large blood transfusion,and appeal to ventilation during cardiopulmonary bypass in N group were much higher than those in C group （P0.05）. Non-invasive positive pressure ventilation improved respiratory rate,arterial oxygen saturation,heart rate,pulmonary arterial pressure,oxygenation index,alveolar-arterial oxygen tension difference in N groups （P0.05）. Noninvasive positive-pressure ventilation had obvious efficiency on cardiogenic pulmonary edema,atelectasis and acute lung injury. There were 2 patients having lung inflammation,and one of them received reintubating. The total efficiency was 95.2% for non-invasive positive pressure ventilation. Conclusion In appropriate candidates,noninvasive positive-pressure ventilation exerts favorable effects on lung function,

关 键 词：肺通气 呼吸功能不全 冠状动脉旁路移植术 非体外循环 无创 

分 类 号：R619[医药卫生—外科学] R654[医药卫生—临床医学]