早期机械通气干预对出血性脑卒中术后低氧血症患者预后的影响研究  

Effect of Early Mechanical Ventilation Intervention on Prognosis of Patients with Hypoxemia after Hemorrhagic Stroke Surgery

作　　者：杨雪辉[1] 朱宁[1] 李晓卫[1] 童莉[1] 张文超[1] 

机构地区：[1]河北医科大学附属哈励逊国际和平医院衡水市人民医院神经外科,河北省衡水市053000

出　　处：《中国全科医学》2017年第5期554-557,共4页Chinese General Practice

基　　金：河北省科技支撑计划资助项目(132777154)

摘　　要：目的探讨早期机械通气干预对出血性脑卒中术后低氧血症患者预后的影响。方法采用前瞻性随机对照研究设计,选取2010年1月—2013年3月河北医科大学附属哈励逊国际和平医院收治的出血性脑卒中术后低氧血症患者144例,采用随机数字表法分为3组,每组48例。A组:积极的早期机械通气干预组,患者术后给予持续末梢血氧饱和度(Sp O_2)及血气分析监测,当持续2 h平均Sp O_2在93%~95%和/或平均动脉血氧分压(Pa O_2)在71~80mm Hg(1 mm Hg=0.133 k Pa),即积极的早期给予机械通气。B组:早期机械通气干预组,当持续2 h平均Sp O_2在91%~92%和/或平均Pa O_2在61~70 mm Hg,给予机械通气。C组:保守机械通气组,待持续2 h平均Sp O_2≤90%和/或平均Pa O_2≤60 mm Hg,才给予机械通气。记录患者呼吸机相关性肺炎(VAP)、术后再出血、脑积水发生率、机械通气持续时间,术后随访6个月时格拉斯哥预后量表(GOS)评分及病死率。结果 3组患者VAP、术后再出血、脑积水发生率及病死率比较,差异均无统计学意义(P>0.05)。3组患者机械通气持续时间及GOS评分比较,差异均有统计学意义(P<0.05);其中A组和B组患者机械通气持续时间短于C组,GOS评分高于C组(P<0.05);A组与B组患者机械通气持续时间及GOS评分比较,差异均无统计学意义(P>0.05)。结论早期机械通气能够缩短出血性脑卒中术后低氧血症患者机械通气持续时间,改善预后。Objective To study the effect of early mechanical ventilation on the prognosis of patients with hypoxemia after hemorrhagic stroke surgery. Methods By prospective randomized controlled study design, 144 patients with hypoxemia after hemorrhagic stroke surgery admitted into Harrison International Peace Hospital Attached to Hebei Medical University from January 2010 to March 2013 were selected. With random nmnber table method, the patients were randomly assigned to three groups and each group had 48 cases. Group A （active intervention group of mechanical ventilation in early stage ） was given continuous monitoring of SpO2 and blood gas analysis after operation. When the average SpO2 continued for two hours was between 93% and 95% and/or the average PaO2 between 71 and 80 mm Hg （ 1 mm Hg =0. 133 kPa） , that was the active early stage to perform mechanical ventilation. Group B （ intervention group of mechanical ventilation in early stage ） was given mechanical ventilation when the average SpO2 continued for two hours was between 91% and 92% and/or the average PaO2 between 61 and 70 mm Hg. Group C （control group, conservative mechanical ventilation group ） was not given mechanical ventilation until the average SpO2 continued for two hours was equal to or less than 90% and/or the average PaO2 equal to or less than 60 mm Hg. The incidence rate of ventilator - associated pneumonia （VAP） , postoperative rebleeding and hydmcephalus, the duration of mechanical ventilation, the score of Glasgow Outcome Scale （GOS） at the sixth month of the follow -up and case fatality rate of patients were recorded in the study. Results There was no significant difference in the incidence rate of VAP, postoperative rebleeding and hydrocephalus and case fatality rate of patients in three groups （ P 〉 0. 05 ）. There was significant difference in the duration of mechanical ventilation and GOS score of patients in three groups （ P 〈 0. 05 ） ; and the duration of mechanical ventilation of patients in group A an

关 键 词：脑出血 连续气道正压通气 预后 

分 类 号：R743.34[医药卫生—神经病学与精神病学]