CAJ | 학술논문

目的探讨无创通气在治疗行体外循环后婴幼儿拔除气管插管后出现的呼吸衰竭的临床应用.方法 63例婴幼儿行心脏手术,术中应用体外循环,心内畸形纠正满意,在拔除气管插管后出现呼吸衰竭.按病种分为无创组(non-invasive,NV组)和气管插管组(invasive,Ⅳ组)两组:NV组应用无创通气治疗,Ⅳ组行气管插管.观察NV组临床症状并监测心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2)、血气等方面的变化；比较两组的并发症、发生院感例数、再次使用呼吸机的时间、ICU停留时间和住院时间.结果 NV组1例死于心功能衰竭,余31例均痊愈出院；其中26例治疗前HR 181(19.7)次/min,RR 54(16.7)次/min,SpO2 87％(10.5％),pH值7.29(0.24),PaCO2 49(31.75)mm Hg(1 mm Hg =0.133 kPa),PaO2 55.5(6)mm Hg；治疗后HR 157(12)次/min,RR 35(3.25)次/min,SpO2 96％ (3％),pH值7.37 (0.15),PaCO2 42(10.5)mm Hg,PaO2 82.5(11) mm Hg,与治疗前HR、RR及PaCO2较降低(P＜0.01),SpO2、pH值、PaO2增高(P＜0.01),较治疗前缓解,无依赖现象；6例病情无改善,改为气管插管；未出现气道出血及喉头水肿.Ⅳ组1例死于心功能衰竭,余30例均痊愈出院；其中1例出现气道出血,4例出现喉头水肿.NV组的院感例/率小于Ⅳ组,NV组再次使用呼吸机的时间42(17.2)h,少于Ⅳ组50(20)h (P ＜0.01),ICU停留时间、住院天数与Ⅳ组相当.结论无创通气可应用于治疗行体外循环后婴幼儿拔除气管插管后出现的呼吸衰竭,是一种安全、有效的方法.
목적 탐토무창통기재치료행체외순배후영유인발제기관삽관후출현적호흡쇠갈적림상응용.방법 63례영유인행심장수술,술중응용체외순배,심내기형규정만의,재발제기관삽관후출현호흡쇠갈.안병충분위무창조(non-invasive,NV조)화기관삽관조(invasive,Ⅳ조)량조:NV조응용무창통기치료,Ⅳ조행기관삽관.관찰NV조림상증상병감측심솔(HR)、호흡빈솔(RR)、혈양포화도(SpO2)、혈기등방면적변화；비교량조적병발증、발생원감례수、재차사용호흡궤적시간、ICU정류시간화주원시간.결과 NV조1례사우심공능쇠갈,여31례균전유출원；기중26례치료전HR 181(19.7)차/min,RR 54(16.7)차/min,SpO2 87％(10.5％),pH치7.29(0.24),PaCO2 49(31.75)mm Hg(1 mm Hg =0.133 kPa),PaO2 55.5(6)mm Hg；치료후HR 157(12)차/min,RR 35(3.25)차/min,SpO2 96％ (3％),pH치7.37 (0.15),PaCO2 42(10.5)mm Hg,PaO2 82.5(11) mm Hg,여치료전HR、RR급PaCO2교강저(P＜0.01),SpO2、pH치、PaO2증고(P＜0.01),교치료전완해,무의뢰현상；6례병정무개선,개위기관삽관；미출현기도출혈급후두수종.Ⅳ조1례사우심공능쇠갈,여30례균전유출원；기중1례출현기도출혈,4례출현후두수종.NV조적원감례/솔소우Ⅳ조,NV조재차사용호흡궤적시간42(17.2)h,소우Ⅳ조50(20)h (P ＜0.01),ICU정류시간、주원천수여Ⅳ조상당.결론 무창통기가응용우치료행체외순배후영유인발제기관삽관후출현적호흡쇠갈,시일충안전、유효적방법.
Objective To evaluate the effects of non-invasive ventilation in the treatment of infants with respiratory failure after cardiopulmonary bypass (CPB) and extubation.Method Sixty-three infants who had undergone successful surgery with CPB,got respiratory failure after extubation.These infants were randomly divided into two groups:non-invasive (NV) group,treated with non-invasive ventilation and invasive (Ⅳ) group,treated with tracheal intubation.The alteration of clinical symptoms,heart rate (HR),respiratory rate (RR),pulse oxygen saturation (SpO2) and blood gas were measured.A comparison was conducted in the incidence of complication and hospital infection,mechanical ventilation time,length of stay in ICU and hospital stay.Result Among the 32 patients in NV group,1 patient died of heart failure,the remaining 31 patients recovered.Of these 32,26 patients had relief of respiratory failure,the HR 181 (19.7) bpm,RR54 (16.7) bpm and PaCO2 55.5(6) mm Hg decreased to 157 (12) bpm,35 (3.25)bpm,and 42 (10.5) mm Hg,meanwhile SpO2 87％ (10.5％),pH 7.29 (0.24),PaO2 55.5(6) mm Hg increased to 96％ (3 ％),7.37 (0.15),82.5 (11) mm Hg after treatment with non-invasive ventilation (P ＜0.01).Six patients underwent tracheal intubation because their condition was not improved.Tracheal hemorrhage or laryngeal edema did not occur in these patients.Among the 31 patients in Ⅳ group,1 patient died of heart failure,the other patients were cured.Of these 30,one patient had tracheal hemorrhage and four patients had laryngeal edema.The incidence of hospital infection in NV group was lower compared with that in Ⅳ group.The mechanical ventilation time in NV group 42 (17.2) h was shorter compared with that in Ⅳ group 50(20) h (P ＜0.01).There was no significant difference in the length of ICU and hospital stay between the two groups.Conclusion Non-invasive ventilation is a safe and effective method to treat infants with respiratory failure after CPB and extubation.