无创通气在治疗婴幼儿体外循环后呼吸衰竭的应用  

Non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass

作　　者：李虔桢[1] 吴锡阶[1] 

机构地区：[1]福建医科大学附属协和医院心脏外科,福州350001

出　　处：《中华儿科杂志》2013年第2期118-121,共4页Chinese Journal of Pediatrics

摘　　要：目的探讨无创通气在治疗行体外循环后婴幼儿拔除气管插管后出现的呼吸衰竭的临床应用。方法63例婴幼儿行心脏手术，术中应用体外循环，心内畸形纠正满意，在拔除气管插管后出现呼吸衰竭。按病种分为无创组（non—invasive，NV组）和气管插管组（invasive，IV组）两组：NV组应用无创通气治疗，IV组行气管插管。观察NV组临床症状并监测心率（HR）、呼吸频率（RR）、血氧饱和度（SpO，）、血气等方面的变化；比较两组的并发症、发生院感例数、再次使用呼吸机的时间、ICU停留时间和住院时间。结果NV组1例死于心功能衰竭，余31例均痊愈出院；其中26例治疗前HR181（19．7）次／min，RR54（16．7）次／min，Sp0287％（10．5％），pH值7．29（0．24），PaC0249（31．75）mmHg（1mmHg：0．133kPa），PaO，55．5（6）mmHg；治疗后HR157（12）次／min，RR35（3．25）次／min，Sp0296％（3％），pH值7．37（0．15），PaC0242（10．5）mmHg，Pa0282．5（11）mmHg，与治疗前HR、RR及PaCO2较降低（P〈0．01），SpO2、pH值、PaO2增高（P〈0．01），较治疗前缓解，无依赖现象；6例病情无改善，改为气管插管；未出现气道出血及喉头水肿。IV组1例死于心功能衰竭，余30例均痊愈出院；其中1例出现气道出血，4例出现喉头水肿。NV组的院感例／率小于IV组，NV组再次使用呼吸机的时间42（17．2）h，少于IV组50（20）h（P〈0．01），ICU停留时间、住院天数与IV组相当。结论无创通气可应用于治疗行体外循环后婴幼儿拔除气管插管后出现的呼吸衰竭，是一种安全、有效的方法。Objective To evaluate the effects of non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass （CPB） and extubation. Method Sixty-three infants who had undergone successful surgery with CPB, got respiratory failure after extubation. These infants were randomly divided into two groups： non-invasive （NV） group, treated with non-invasive ventilation and invasive （IV） group, treated with tracheal intubation. The alteration of clinical symptoms, heart rate （HR）, respiratory rate （ RR）, pulse oxygen saturation （ SpO2 ） and blood gas were measured. A comparison was conducted in the incidence of complication and hospital infection, mechanical ventilation time, length of stay in ICU and hospital stay. Result Among the 32 patients in NV group, 1 patient died of heart failure, the remaining 31 patients recovered. Of these 32, 26 patients had relief of respiratory failure, the HR 181 （19. 7） bpm, RR 54 （16. 7） bpm and PaCO2 55.5（6） mm Hg decreased to 157 （12） bpm, 35 （3.25） bpm, and 42 （ 10. 5） mm Hg, meanwhile SpO2 87% （ 10. 5% ）, pH 7.29 （0. 24）, PaO2 55.5（6） mm Hg increased to 96% （ 3 % ）, 7.37 （0. 15 ）, 82. 5 （ 11 ） mm Hg after treatment with non-invasive ventilation （ P 〈0. 01 ）. Six patients underwent tracheal intubation because their condition was not improved. Tracheal hemorrhage or laryngeal edema did not occur in these patients. Among the 31 patients in IV group, 1 patient died of heart failure, the other patients were cured. Of these 30, one patient had tracheal hemorrhage and four patients had laryngeal edema. The incidence of hospital infection in NV group was lower compared with that in IV group. The mechanical ventilation time in NV group 42 （17.2） h was shorter compared with that in IV group 50（20）h （P 〈0. 01 ）. There was no significant difference in the length of ICU and hospital stay between the two groups. Conclusion Non-invasive ventilation is a safe and effective

关 键 词：无创通气 婴幼儿 体外循环 呼吸衰竭 

分 类 号：R726[医药卫生—儿科]