无创正压通气在重症加强治疗病房非计划拔管患者中的应用  

Application of noninvasive ventilation in patients with unplanned extubation in intensive care unit

作　　者：农凌波[1] 刘冬冬[1] 余裕恒 梁微波[1] 陈思蓓[1] 徐永昊[1] 桑岭[1] 刘学松[1] 杨淳[1] 周静[1] 何为群[1] 黎毅敏[1] 刘晓青[1] NONG Lingbo;LIU Dongdong;YU Yuheng;LIANG Weibo;CHEN Sibei;XU Yonghao;SANG Ling;LIU Xuesong;YANG Chun;ZHOU Jing;HE Weiqun;LI Yimin;LIU Xiaoqing(Department of Critical Care Medicine,Guangzhou Institute of Respiratory Health,The First)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院

出　　处：《中国呼吸与危重监护杂志》2019年第6期527-531,共5页Chinese Journal of Respiratory and Critical Care Medicine

基　　金：国家科技重大专项课题(2017ZX10204401003)

摘　　要：目的评估无创正压通气(NIV)在重症加强治疗病房(ICU)非计划拔管(UE)患者中的应用价值。方法回顾性分析2014年1月至2018年12月在广州医科大学附属第一医院、广州呼吸健康研究院ICU中UE患者的临床资料、NIV的应用、重新插管率及预后情况。根据UE后NIV的应用情况将患者分为对照组和NIV组。比较两组患者各项指标的差异,评估NIV在UE患者中的应用效果。结果本研究共纳入66例UE患者,男44例,女22例,平均年龄(64.2±16.1)岁,对照组41例(62.1%)患者UE后使用鼻导管或者面罩吸氧,另外25例(37.9%)患者使用NIV。对照组和NIV组急性生理学和慢性健康状况评分系统Ⅱ评分分别为(18.6±7.7)和(14.8±6.3)分,差异有统计学意义(P=0.043)。对照组和NIV组呼吸衰竭的原因分别为:肺炎16例(39.0%)比7例(28.0%),术后呼吸衰竭7例(17.1%)比8例(32.0%),慢性阻塞性肺疾病8例(19.5%)比6例(24.0%),其他原因5例(12.2%)比4例(16.0%),心功能衰竭3例(7.3%)比0例(0%),神经系统疾病2例(4.9%)比0例(0%),两组病因比较差异均无统计学意义。UE前通气时间(12.5±19.8)d比(12.7±15.2)d(P=0.966),拔管前对照组和NIV组Pa O2(114.9±37.4)比(114.4±46.3)mm Hg(P=0.964),氧合指数(267.1±82.0)比(257.4±80.0)mm Hg(P=0.641),重新插管率65.9%比24.0%(P=0.001),机械通气时间(23.9±26.0)比(21.8±26.0)d(P=0.754),ICU住院时间(34.4±36.6)比(28.5±25.8)d(P=0.48)。本研究总死亡率19.7%,对照组与NIV组死亡率分别为22.0%和16.0%(P=0.555)。结论 ICU中的UE患者可以考虑使用NIV来避免重新插管。Objective To investigate the application value of noninvasive ventilation(NIV) performed in patients with unplanned extubation(UE) in intensive care unit(ICU). Methods This was a retrospective analysis. The clinical data, application of NIV, reintubation rate and prognosis of UE patients in the ICU of this hospital from January 2014 to December 2018 were reviewed, and the patients were assigned to the control group or the NIV group according to the application of NIV after UE. The data between the two groups were compared and the application effects of NIV in UE patients were evaluated. Results A total of 66 UE patients were enrolled in this study, including 44 males and 22 females and with an average age of(64.2±16.1) years. Out of them, 41 patients(62.1%) used nasal catheter or mask for oxygenation as the control group, 25 patients(37.9%) used NIV as the NIV group. The Acute Physiology and Chronic Health EvaluationⅡ score of the control group and the NIV group were(18.6±7.7) vs.(14.8±6.3), P=0.043. The causes of respiratory failure in the control group and the NIV group were as follows: pneumonia 16 patients(39.0%) vs. 7 patients(28.0%), postoperative respiratory failure 7 patients(17.1%) vs. 8 patients(32.0%), chronic obstructive pulmonary disease8 patients(19.5%) vs. 6 patients(24.0%), others 5 patients(12.2%) vs. 4 patients(16.0%), heart failure 3 patients(7.3%) vs.0 patients(0%), nervous system diseases 2(4.9%) vs. 0 patients(0%), which showed no significant difference between the two groups. Mechanical ventilation time before UE were(12.5±19.8) vs(12.7±15.2) d(P=0.966), Pa O2 of the control group and the NIV group before UE was(114.9±37.4) vs.(114.4±46.3)mm Hg(P=0.964), and oxygenation index was(267.1±82.0) vs.(257.4±80.0)mm Hg(P=0.614). Reintubation rate was 65.9% in the control group and 24.0% in the NIV group(P=0.001). The duration of mechanical ventilation was(23.9±26.0) vs.(21.8±26.0)d(P=0.754), the length of stay in ICU was(34.4±36.6) vs.(28.5±25.8)d(P=0.48). The total mortality rate i

关 键 词：非计划拔管 无创正压通气 重新气管插管 重症加强治疗病房 

分 类 号：R47[医药卫生—护理学]