无创通气降低腹部手术后呼吸衰竭患者气管再插管风险的研究  

Risk of reducing endotracheal reintubation in patients with respiratory failure after abdominal surgery by noninvasive ventilation

作　　者：董宏 钱秦娟 张英 费志永 康珍 

机构地区：[1]天津海滨人民医院重症医学科,天津300280

出　　处：《中国急救医学》2017年第11期1011-1015,共5页Chinese Journal of Critical Care Medicine

基　　金：天津卫生局科技基金（2015KTA）01）

摘　　要：目的评价无创机械通气（NIV）对腹部手术后低氧性呼吸衰竭患者气管再插管的影响。方法选取在我院ICU治疗的348例腹部手术后7d内发生低氧性呼吸衰竭的患者，根据随机数字表法，将患者分为两组，即接受NIV治疗组（NIV组，n=173）和标准氧治疗组（标准氧疗组，n=175），治疗从完成随机分组开始共进行30d或至离开ICU止。比较两组患者气管再插管率、无创通气时间、治疗相关感染发生率与病死率。结果NIV组患者7d内再次插管发生率明显低于标准氧疗组[57（32．9％）VS．80（45．7％），X^2=5．940，P=0．015]；与标准氧疗组比较，NIV组患者无创通气时间明显提高[（25．5±4．2）dvs．（20．6±3．8）d，t=11．415，P〈0．001]，NIV组患者30d内感染发生率更低[54（31．2％）vs．86（49．1％），x^2=11．630，P〈0．001]，NIV组患者7d内[17（9．8％）VS．39（22．3％），x^2=10．002，P=0．002]与30d内[25（14．5％）VS．52（29．7％），x^2=11．763，P〈0．001]肺炎发生率更低。两组患者ICU住院时间与病死率比较差异无统计学意义（均P〉0．05）。多变量分析表明，NIV与患者气管再插管负相关（OR=0．496，95％CI 0．231—0．817，P=0．007）。结论与标准氧疗比较，NIV能降低腹部手术后低氧性呼吸衰竭患者术后气管插管的风险。Objective To evaluate the effect of noninvasive ventilation （NIV） on endotracheal reintubation in patients with hypoxic respiratory failure after abdominal surgery. Methods The patients with hypoxic respiratory failure within 7 days after abdominal surgery in our hospital ICU were randomly divided into two groups according to the random number table method. The patients were treated with NIV （NIV group, n = 173 ） treatment or standard oxygen treatment （standard oxygen therapy group, n = 175 ）. The treatment was performed for 30 days from completion of randomization, or to leave ICU. The endotracheal reintubation rate, noninvasive ventilation time, treatment - related infection and mortality were compared between the two groups. Results The number of patients endotraeheal re - intubated in the NIV group was significantly lower than that in the standard oxygen therapy group [ 57 （32.9%） vs. 80 （45.7%） , X^2 = 5. 940, P = 0. 015 ]. Compared with the standard oxygen therapy group, the NIV group had no significant improvement in noninvasive ventilation time [ （ 25.5 ± 4.2 ） d vs. （20.6 ±3.8） d, t =11.415, P〈0.001]. The patients in the NIV group had fewer infections[54 （31.2% ） vs. 86 （49. 1% ） , X^2 = 11. 630, P 〈 0. 001 ]. The patients in group NIV had fewer patients with pneumonia within 7 days [ 17 （9.8%） vs. 39 （22.3%）, X2 = 10. 002, P =0.002 ] and 30 days [25 （14.5%） vs. 52 （29.7%）, X^2 = 11. 763, P 〈 0. 001 ]. There was no statistically significant difference in ICU hospitalization time between the two groups （ P 〉 0.05 ）. Multivariate analysis showed that NIV was negatively correlated with endotracheal reintubation （OR = 0. 496, 95% CI 0. 231 - 0.817, P = 0. 007 ）. Conclusion Noninvasive ventilation can reduce the risk of endotracheal reintubation in patients with hypoxic respiratory failure after abdominal surgery compared with standard oxygen therapy.

关 键 词：无创机械通气(NIV) 气管再插管 呼吸衰竭 

分 类 号：R473.5[医药卫生—护理学]