无创正压通气不同界面在改善冠状动脉旁路移植术后低氧血症的研究  

Effects of noninvasive positive pressure ventilation with different interfaces on hypoxemic patients after coronary artery bypass grafting surgery

作　　者：杨毅[1] 刘楠[1] 侯晓彤[1] 孙立忠[2] 王红[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科危重症中心,100029 [2]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心外科,100029

出　　处：《心肺血管病杂志》2016年第2期110-115,共6页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:比较研究无创正压通气不同界面在改善冠状动脉旁路移植术(CABG)后低氧血症方面的作用。方法:选择2013年12月至2014年10月,北京安贞医院心脏外科因CABG,术后拔除气管插管之后24h内发生低氧血症(hypoxima)、符合纳入标准的50例患者,随机分为两组应用无创头罩或面罩进行无创正压通气(NPPV),比较2种通气界面的效能。结果:比较2种通气界面,发现头罩在改善p H、Pa O2、Sp O2及Pa O2/Fi O2在治疗后1h、6h及治疗结束时,均较面罩组效果明显(P<0.05),可快速改善氧合;降低Pa CO2于6h时开始出现明显效果持续到治疗结束,较mask组疗效显著(P<0.05);心率(HR)在6h、治疗结束时头罩组均较面罩组有明显下降(P<0.05);治疗结束时胃肠胀气、不耐受及面部压疮等主要并发症发生率及治疗失败率的比较,头罩组较面罩组为低(P<0.05);NPPV治疗时间头罩组明显较面罩组为短(P<0.05);再次插管、气管切开发生率二组差异无统计学意义(P>0.05);重症监护室(ICU)时间、住院时间、ICU病死率及住院病死率,差异无统计学意义(P>0.05)。结论:无创helmet能够快速起效,更快的提高Pa02,降低Pa C02,且对循环的改善也有良好作用,达到治疗目标所需时间短,耐受性好,舒适度更高,并发症少。Objective： To compare the effects of helmet model and mask model of Noninvasive Positive Pressure Ventilation（ NPPV） on patients with hypoxemia after Coronary Artery Bypass Grafting（ CABG） surgery. Methods： 50 hypoxemic CABG patients after extubation in 24 hs in the Department of Cardiac Surgery,Beijing Anzhen Hospital were included between December 2013 and October 2014. The patients were randomly divided into helmet model and mask model groups to receive NPPV ventilation. The ventilation support effects were compared between these two interfaces. Results： Helmet NPPV ventilation could better improve p H,Pa O2,Sp O2,and Pa O2/ Fi O2 at the initial,maintenance,and end stage comparing with the mask NPPV group（ P〈0. 05）. The helmet NPPV ventilation could better decrease Pa CO2 since 6-hour after the treatment till the end of the treatment（ P〈0. 05）. Heart rates were better reduced significantly in the maintenance and end stages of the helmet group（ P〈0. 05）. Incidences of flatulence,intolerance,and facial pressure sore were significantly lower in the helmet group（ P〈0. 05）. NPPV treatment time was significantly shorter in the helmet group（ P〈0. 05）,while the reintubation and tracheotomy rates showed no significant difference between two groups（ P〈0. 05）. Intensive care unit（ ICU） stay time,hospitalization time,ICU mortality,and in-hospital mortality are statistically no difference（ P〈0. 05）. Conclusion： Comparing with mask NPPV,the effects of helmetNPPV could more rapidly increase PaO 2and reduce PaC O2,and thus effectively shorten the treatment time,increase the tolerance and comfortableness,reduce the complications. But the reintubation rate,tracheotomy rate,ICU mortality,in-hospital mortality,ICU time,hospitalization time were not significantly different between the two groups.

关 键 词：无创正压通气 冠状动脉旁路移植术 低氧血症 头罩 

分 类 号：R54[医药卫生—心血管疾病]