CAJ | 학술논문

目的评价无创正压通气(NIPPV)治疗全身麻醉手术拔管后呼吸衰竭的疗效及影响因素.方法全麻手术拔管后48 h内发生呼吸衰竭的患者34例,应用BiPAP Vision呼吸机实施无创正压通气治疗,比较治疗后避免再插管(成功组)和需要再插管(失败组)患者的基础状态、通气疗效及临床结果,并分析可能的影响因素.结果无创正压通气使70.6%的术后呼吸衰竭患者避免插管.与失败组相比,成功组心肺并发症所致呼吸衰竭的比例和需要人工辅助吸痰的比例明显低(P<0.05),麻醉药残留呼吸抑制的比例高(P<0.01).结论无创正压通气治疗全身麻醉手术后呼吸衰竭能够减少再插管率,但可能不适用于存在心肺并发症和排痰障碍的患者.
목적 평개무창정압통기(NIPPV)치료전신마취수술발관후호흡쇠갈적료효급영향인소.방법 전마수술발관후48 h내발생호흡쇠갈적환자34례,응용BiPAP Vision호흡궤실시무창정압통기치료,비교치료후피면재삽관(성공조)화수요재삽관(실패조)환자적기출상태、통기료효급림상결과,병분석가능적영향인소.결과 무창정압통기사70.6%적술후호흡쇠갈환자피면삽관.여실패조상비,성공조심폐병발증소치호흡쇠갈적비례화수요인공보조흡담적비례명현저(P<0.05),마취약잔류호흡억제적비례고(P<0.01).결론 무창정압통기치료전신마취수술후호흡쇠갈능구감소재삽관솔,단가능불괄용우존재심폐병발증화배담장애적환자.
Objective To assess the efficacy of noninvasive positive pressure ventilation (NIPPV) in treating acute respiratory failure(ARF) after extubation. Methods Thirty-four patients with ARF required ventilatory support after extubation were treated with NIPPV and divided into group A(not reintubated,24 cases) and group B(reintubated, 10 cases). The data of ASA physical status, APACHE Ⅱ score, and Glasgow dyspepsia severity score were collected at admission to ICU. Arterial blood gases and respiratory rate before, at 30 min, 1 h, 2 h after NIPPV and the end of NIPPV were analyzed. Results At admission, the patients in two groups had similar demographic characteristics, ASA grading, APACHE Ⅱ scores, Glasgow scores and PaO2/fraction of inspired oxygen(FiO2) ratio, which were improved after treatment with NIPPV (P<0.05). Reintubation was avoided in 24(70.6%) patients after NIPPV. Compared with group B, the patients in group A had more increase of PaO2/FiO2 and less percentage of pneumonocirrhosis and requiring suction (P< 0.05). Conclusion NIPPV is helpful in improving the repiratory function and reducing reintubation rate in the patients with ARF requiring ventilatory support after extubation of general anesthesia, but may not be suitable in the cases with pneumonocirrhosis or difficulty of sputum cleaning.