无创正压通气对胸外科患者术后肺部感染的影响研究  

The effect of noninvasive positive pressure ventilation on prevention of pulmonary infections after thoracic surgery

作　　者：张华[1] 李伟[2] 崔红赏[1] 

机构地区：[1]河北省人民医院胸外科,河北石家庄050051 [2]河北省人民医院体检中心,河北石家庄050051

出　　处：《中华医院感染学杂志》2015年第12期2808-2810,共3页Chinese Journal of Nosocomiology

基　　金：河北省卫生厅科研基金资助项目(20110228)

摘　　要：目的探讨无创正压通气对胸外科患者术后肺部感染的影响,为临床治疗提供参考依据。方法选取2010年1月-2013年1月医院收治的120例胸外科手术患者,将其随机分成对照组和观察组,每组各60例,其中对照组患者给予常规治疗,观察组患者则在常规治疗基础上给予无创正压通气治疗,比较两组患者有创通气率、氧分压(PaO2)和二氧化碳分压(PaCO2)水平以及两组患者术后肺部并发症发生率。结果两组患者治疗后,肺部感染率观察组为3.3%,明显低于对照组的20.0%,差异有统计学意义(P<0.05);有创通气率观察组为3.3%明显低于对照组的11.7%,差异有统计学意义(P<0.05);观察组患者术后1、2、3hPaO2水平分别为(74.6±9.1)、(84.2±9.2)、(94.9±9.4)mm Hg,均低于对照组的(85.2±10.1)、(97.3±10.8)、(124.3±12.4)mm Hg,PaCO2水平分别为(49.8±2.0)、(47.7±1.8)、(46.2±1.4)mm Hg,均高于对照组的(42.8±1.7)、(39.7±1.3)、(37.2±1.5)mm Hg,两组患者PaO2及PaCO2比较,差异均有统计学意义(P<0.05);观察组患者术后支气管痉挛发生率为3.3%,均明显低于对照组的11.7%,差异有统计学意义(P<0.05)。结论无创正压通气明显降低胸外科手术患者的肺部感染率,减少术后并发症的发生,改善患者术后通气状况,值得临床推广应用。OBJECTIVE To investigate the effect of noninvasive positive pressure ventilation on prevention of pulmonary infections after thoracic surgery ,so as to provide reference for clinical treatment .METHODS Totally 120 cases of thoracic surgery patients during Jan .2010 to Jan .2013 in our hospital were randomly divided into the control group and the observation group ,60 patients in each group ,and the control group was treated with conventional treatment ,the observation group was treated with noninvasive positive pressure ventilation therapy on the basis of conventional therapy . The invasive ventilation rate , PaO2 and PaCO2 levels and postoperative pulmonary complications of the two groups of patients were compared .RESULTS After treatment ,the rate of lung infection was 3 .3% in the observation group ,significantly lower than 20 .0% in the control group （P〈0 .05） . The rate of invasive ventilation in patients of the observation group was 3 .3% ,significantly lower than 11 .7% in the control group （P〈0 .05） .The PaO2 levels at 1 h ,2 h and 3 h after thoracic surgery of the patients in the observation group were （74 .6 ± 9 .1）mm Hg ,（84 .2 ± 9 .2） mm Hg ,and （94 .9 ± 9 .4）mmHg ,lower than （85 .2 ± 10 .1）mm Hg ,（97 .3 ± 10 .8） mmHg ,（124 .3 ± 12 .4）mm Hg in the control group （P〈0 .05） .The PaCO2 lev‐els at 1 h ,2 h and 3 h after thoracic surgery in the observation group were （49 .8 ± 2 .0） mm Hg ,（47 .7 ± 1 .8） mm Hg ,and （46 .2 ± 1 .4） mm Hg ,higher than （42 .8 ± 1 .7）mm Hg ,（39 .7 ± 1 .3） mm Hg ,and （37 .2 ± 1 .5） mm Hg in the control group （P〈0 .05） .The incidence of bronchospasm in the observation group was 3 .3% , significantly lower than 11 .7% in the control group （ P〈 0 .05 ） .CONCLUSION Noninvasive positive pressure ventilation could reduce the incidence of lung infections and postoperative complications ,and improve patients′postoperative ventilation ,which was worthy of clinical application .

关 键 词：无创正压通气 胸外科 肺部感染 

分 类 号：R619.3[医药卫生—外科学]