慢性阻塞性肺病病人术后无创正压通气的临床研究  

Noninvasive positive pressure ventilation for patients with chronic obstructive pulmonary disease after upper abdominal and thoracic surgery

作　　者：薛张纲[1] 白浪[1] 马琦[1] 蒋豪[1] 

机构地区：[1]上海医科大学附属中山医院麻醉科,200032

出　　处：《中华麻醉学杂志》2000年第3期145-148,共4页Chinese Journal of Anesthesiology

摘　　要：目的　比较术后常规治疗 (SMT)加无创正压通气 (NPPV)和单独应用常规治疗对伴有中、重度呼吸功能不全的慢性阻塞性肺病人的疗效。方法　择期上腹部和胸腔手术病人 2 4例 ,术前检查有慢性阻塞性肺病合并中度和重度呼吸功能不全 ,随机分成 2组。对照组 :术后常规吸氧、静注氨茶碱、雾化吸入α2 肾上腺素能受体兴奋剂和胆碱能受体拮抗剂、静注敏感抗生素和胸部理疗。NPPV组 :在上述常规治疗基础上加NPPV ,术后即用面罩给予间断压力支持通气 (PSV) ,持续气道正压 (CPAP)为 3cmH2 O ,吸入氧浓度 (FiO2 )为 35 %。结果　对照组中 8例 (6 6 7% )和NPPV组中的所有病人 (10 0 0 % )均顺利康复 ,两组相比有显著性差异 (P <0 0 5 )。对照组中有 4例采用常规治疗而病情恶化 ,随即加用NPPV ,之后病情好转并顺利康复。NPPV组的PaO2 、肺活量 (VC)、一秒率(FEV1/FVC)和呼气中期流速 (FEF2 5% 75% )均明显高于对照组 (P <0 0 5 )。NPPV组的病人在外科监护病房 (SICU)的时间短于对照组 (P <0 0 5 )。结论　术后早期预防性使用NPPV对于伴有中、重度呼吸功能不全的慢阻肺病人有利于改善呼吸功能。Objective To compare the efficacy of postoperative noninvasive positive pressure ventilation ( NPPV ) plus standard medical therapy ( SMT) with SMT alone in patients with moderate to severe chronic obstructive pulmonary disease ( COPD )Methods Twenty-four patients, after upper abdominal or thoracic surgery, who suffered from COPD and moderate to severe respiratory insufficiency, were randomly allocated to receiving SMT alone (oxygen, aminophylline infusion, nebulized beta-2 agonists and anticholinergics, antibiotics administration and chest physiotherapy; control group ,n=12) or NPPV in addition to SMT(NPPV group ,n=12) NPPV was intermittently given with an air-cushioned face mask under the continuous positive airway pressure of 3 cmH 2O and FiO2 of 35%Results There were not significant differences in baselines between both groups 8 patients in control group ( 667%) and all patients in NPPV group recovered with initial therapy with statistically significant difference (P<0 05 ) The conditions of 4 patients in control group deteriorated ,and were improved greatly following the addition of NPPV As compared with those in control group ,PaO 2, vital capacity(VC), first second forced expiratory volume rate (FEV 1/FVC) and the mean forced expiratory flow during the middle half of the forced vital capacity(FEF 25%-75%) increased significantly in NPPV group (P<0 05 ) In NPPV group the patients had a shorter duration of stay in SICU than in control group (P<005 )Conclusions Prophylactic use of NPPV in the postoperative patients with moderate to severe COPD facilitates the improvement

关 键 词：间歇正压通气 阻塞性肺疾病 呼吸功能试验 面罩 

分 类 号：R655.3[医药卫生—外科学]