无创正压通气治疗心脏术后低氧血症失败原因分析  

Failure Factors of Noninvasive Positive Pressure Ventilation for Hypoxemia after Cardiac Surgery

作　　者：任海波[1] 刘彬[1] 李颖[1] 危宇[1] 肖红艳[1] 

机构地区：[1]武汉亚洲心脏病医院ICU,武汉430022

出　　处：《中国胸心血管外科临床杂志》2016年第9期889-893,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

摘　　要：目的分析无创正压通气（non—invasivepositivepressureventilation，NPPV）治疗心脏术后低氧血症失败原因，以期更好地指导在心外科术后使用NPPV。方法2012年1月至2013年12月武汉亚洲心脏病医院心脏外科手术后共有64例因低氧血症行NPPV治疗，年龄28—87岁，男49例、女15例。其中17例失败，对可能导致NPPV失败的相关因素进行单因素和多因素分析。结果NPPV失败的相关因素有：吸烟史、术前肺功能异常、输血量〉1000ml、NPPV前简化急性生理学评分Ⅱ（simplifiedacutephysiologyscoreⅡ，SAPSⅡ）〉35分、NPPV前氧合指数（Pa02／Fi02）〈100mmHg、NPPV治疗后1hPaO：／FiO2〈150mmHg，第一次机械通气时间〉72h和肺部感染（P均〈O．05）。其中NPPV前SAPSⅡ〉35分和肺部感染是心脏术后低氧血症NPPV治疗失败的独立相关因素。结论心脏术后使用NPPV时应根据导致低氧的原因及病情严重程度选择病例，对NPPV前SAPSⅡ〉35分和肺部感染患者应避免选择NPPV，在使用过程中严密监护，效果不佳时及时转为有创通气。Objective To explore the reason of failure in noninvasive positive pressure ventilation （NPPV） for treatment of postoperative hypoxemia, in order to better guide use of NPPV after cardiac surgery. Methods We retros- pectively analyzed the clinical data of 64 patients after heart surgery with undergoing NPPV treatment due to hypoxemia in our hospital between January 2012 and December 2013 year.There were 49 males and 15 females at age of 28 to 87 years. There were 17 patients with NPPV failure. The related factors for failure of NPPV were analyzed. Results Factors associated with failure of NPPV included smoking history, preoperative pulmonary function abnormalities, blood trans- fusion amount 〉 1 000 ml, simplified acute physiology score II （SAPS lI ） before NPPV〉35 points, oxygenation index （PaOa/FiO2） 〈100 mm Hg before NPPV, PaOa/FiO2 〈150 mm Hg after NPPV treatment for 1 h, mechanical ventilation time 〉72 h at the first time, and pneumonia （P〈0.05）. The SAPS II 〉35 points before NPPV and pneumonia were the independent risk factors for NPPV treatment failure for postoperative hypoxemia. Conclusion Postoperative NPPV for heart disease should be according to the cause of low oxygen and severity. For patients with SAPS less than 35 points before NPPV or patients with pneumonia, NPPV should not be used. In the process of NPPV, if clinical effect is not satisfied, it should be converted to invasive ventilation immediately.

关 键 词：无创正压通气 低氧血症 简化急性生理学评分Ⅱ 肺部感染 

分 类 号：R654.2[医药卫生—外科学]