海南医学
海南醫學
해남의학
HAINAN MEDICAL JOURNAL
2015年
15期
2196-2198
,共3页
有创通气治疗%左心衰%呼吸衰竭%无创正压通气
有創通氣治療%左心衰%呼吸衰竭%無創正壓通氣
유창통기치료%좌심쇠%호흡쇠갈%무창정압통기
Invasive ventilation therapy%Left heart failure%Respiratory failure%Noninvasive positive pres-sure ventilation (NIPPV)
目的：探讨有创通气治疗急性左心衰合并Ⅱ型呼吸衰竭患者采用无创正压通气(NIPPV)序贯治疗的时机。方法选取本院2012年12月至2014年12月收治的92例先行气管插管有创通气治疗的急性左心衰竭合并Ⅱ型呼吸衰竭患者为研究对象，所有患者按自主呼吸试验的时间长短分为三组，A组30例在自主呼吸试验时间30 min拔管，B组31例在2 h后拔管，C组31例在24 h后进行拔管。所有患者均在拔管后开始NIPPV序贯治疗，观察比较不同时间点NIPPV序贯治疗后的脱机成功率、呼吸机相关肺炎(VAP)发生率和血气分析结果。结果三组患者脱机成功率分别为10.00%、80.65%、83.87%，B组和C组脱机成功率明显高于A组，差异均有统计学意义(P<0.05)，而B组和C组相似，差异无统计学意义(P>0.05)；A组患者VAP发生率为43.33%，明显高于B组的12.90%、C组的9.68%，差异均有统计学意义(P<0.05)；血气分析结果发现，三组患者接受无创通气后的pH值、氧分压、二氧化碳分压、氧合指数、心率、呼吸频率与拔管时比较差异均无统计学意义(P>0.05)。结论自主呼吸试验时间>2 h时，呼吸衰竭患者可拔管予以NIPPV序贯治疗，其脱机成功率高，且可降低48 h再插管率，值得临床推广。
目的：探討有創通氣治療急性左心衰閤併Ⅱ型呼吸衰竭患者採用無創正壓通氣(NIPPV)序貫治療的時機。方法選取本院2012年12月至2014年12月收治的92例先行氣管插管有創通氣治療的急性左心衰竭閤併Ⅱ型呼吸衰竭患者為研究對象，所有患者按自主呼吸試驗的時間長短分為三組，A組30例在自主呼吸試驗時間30 min拔管，B組31例在2 h後拔管，C組31例在24 h後進行拔管。所有患者均在拔管後開始NIPPV序貫治療，觀察比較不同時間點NIPPV序貫治療後的脫機成功率、呼吸機相關肺炎(VAP)髮生率和血氣分析結果。結果三組患者脫機成功率分彆為10.00%、80.65%、83.87%，B組和C組脫機成功率明顯高于A組，差異均有統計學意義(P<0.05)，而B組和C組相似，差異無統計學意義(P>0.05)；A組患者VAP髮生率為43.33%，明顯高于B組的12.90%、C組的9.68%，差異均有統計學意義(P<0.05)；血氣分析結果髮現，三組患者接受無創通氣後的pH值、氧分壓、二氧化碳分壓、氧閤指數、心率、呼吸頻率與拔管時比較差異均無統計學意義(P>0.05)。結論自主呼吸試驗時間>2 h時，呼吸衰竭患者可拔管予以NIPPV序貫治療，其脫機成功率高，且可降低48 h再插管率，值得臨床推廣。
목적：탐토유창통기치료급성좌심쇠합병Ⅱ형호흡쇠갈환자채용무창정압통기(NIPPV)서관치료적시궤。방법선취본원2012년12월지2014년12월수치적92례선행기관삽관유창통기치료적급성좌심쇠갈합병Ⅱ형호흡쇠갈환자위연구대상，소유환자안자주호흡시험적시간장단분위삼조，A조30례재자주호흡시험시간30 min발관，B조31례재2 h후발관，C조31례재24 h후진행발관。소유환자균재발관후개시NIPPV서관치료，관찰비교불동시간점NIPPV서관치료후적탈궤성공솔、호흡궤상관폐염(VAP)발생솔화혈기분석결과。결과삼조환자탈궤성공솔분별위10.00%、80.65%、83.87%，B조화C조탈궤성공솔명현고우A조，차이균유통계학의의(P<0.05)，이B조화C조상사，차이무통계학의의(P>0.05)；A조환자VAP발생솔위43.33%，명현고우B조적12.90%、C조적9.68%，차이균유통계학의의(P<0.05)；혈기분석결과발현，삼조환자접수무창통기후적pH치、양분압、이양화탄분압、양합지수、심솔、호흡빈솔여발관시비교차이균무통계학의의(P>0.05)。결론자주호흡시험시간>2 h시，호흡쇠갈환자가발관여이NIPPV서관치료，기탈궤성공솔고，차가강저48 h재삽관솔，치득림상추엄。
Objective To investigate the timing of noninvasive positive pressure ventilation (NIPPV) as se-quential therapy during invasive ventilation for patients with acute left heart failure complicating typeⅡrespiratory failure. Methods Ninety-two patients who underwent invasive ventilation for acute left ventricular failure complicat-ed with typeⅡrespiratory failure from December 2012 to December 2014 in our hospital were enrolled in the study. According to the time of spontaneous breathing trial, the patients were divided into three groups:group A (30 cases, underwent extubation 30 min after spontaneous breathing trial), group B (31 cases, underwent extubation 2 h after spontaneous breathing trial), group C (31 cases, underwent extubation 24 h after spontaneous breathing trial). All pa-tients received NIPPV after extubation as sequential therapy. The success rate of weaning from the ventilator, the inci-dence of ventilator associated pneumonia (VAP), blood gas analysis results were compared at different time points af-ter NIPPV. Results The success rate of weaning from the ventilator were 10.00%, 80.65%, 83.87%in group A, B, C, respectively. The rates in group B and group C were significantly higher than that in group A (P<0.05), while the rates in group B and C showed no statistically significant difference (P>0.05). The incidence of VAP was 43.33%in group A, significantly higher than 12.90%in group B and 9.68%in group C (P<0.05). Blood gas analysis showed that there was no statistically significant difference in all the three groups in pH value, the partial pressure of oxygen, partial pressure of carbon dioxide, oxygenation index, heart rate, respiratory rate between after NIPPV and at extubation (P>0.05). Conclusion For patients with acute left heart failure complicating typeⅡrespiratory failure, when spontane-ous breathing keeps over 2 hours, extubation can be made and NIPPV sequential therapy can started, which will lead to a higher successful rate of weaning from ventilator without increase of re-intubation rate within 48 hours.
