摘要
目的探讨序贯无创通气(NIV)在冠状动脉旁路移植术(CABG)后患者机械通气撤机中的应用。方法将2007年7月至2009年7月在我院行单纯CABG后机械通气≥24h、氧合指数<150mmHg的52例患者纳入研究,采用随机数字表法分为两组,序贯无创通气组(SNIV组):19例,男16例,女3例;年龄69.26±8.10岁;延迟撤机组(PMV组):33例,男28例,女5例;年龄70.06±7.09岁。比较两组患者的临床指标,观察NIV对患者循环、呼吸功能的影响。结果 SNIV组首次撤机时间早于PMV组(26.46±3.66hvs.38.65±9.12h,P=0.013);SNIV组总辅助呼吸时间(29.26±21.56hvs.54.45±86.57h,P=0.016),住ICU时间(2.44±2.99dvs.4.89±7.42d,P=0.028)和术后住院时间(10.82±4.31dvs.14.01±19.30d,P=0.039)均短于PMV组;肺部感染率(5.26%vs.30.30%,P=0.033;)和术后总并发症发生率(10.53%vs.45.45%,P=0.030)均低于PMV组;而撤机成功率、二次气管内插管率、气管切开率、肺部其他并发症发生率及术后30d病死率等两组比较差异无统计学意义(P>0.05)。行NIV后,SNIV组患者心率、中心静脉压、肺动脉压、肺动脉楔压与基线值比较无明显变化(P>0.05);而收缩压(129.66±19.11mmHgvs.119.01±20.31mmHg,P=0.031),心排血量指数[3.01±0.30L/(min.m2)vs.2.78±0.36L/(min.m2),P=0.043]和氧合指数(205.95±27.40mmHgvs.141.33±9.98mmHg,P=0.000)则明显升高。结论序贯NIV是CABG术后机械通气有效和安全的撤机方式。
Objective To investigate the application of sequential non-invasive ventilation （NIV） in weaning patients off mechanical ventilation after coronary artery bypass grafting （CABG）.Methods From July 2007 to July 2009,52 patients who underwent CABG with mechanical ventilation for no less than 24 hours and P/F Ratio lower than 150 mm Hg were divided into two groups with random number table.In the sequential NIV group （SNIV group）,there were 19 patients including 16 males and 3 females whose ages were 69.26±8.10 years.In the prolonged mechanical ventilation group （PMV group）,there were 33 patients including 28 males and 5 females whose ages were 70.06±7.09 years.Clinical data of these two groups were compared and the influence of NIV on the circulation and respiration of the patients were observed.Results The SNIV group weaned off mechanical ventilation earlier than the PMV group （26.46±3.66 h vs.38.65±9.12 h,P=0.013）.The SNIV group held shorter total ventilation time （29.26±21.56 h vs.54.45±86.57 h,P=0.016）,ICU stay time （2.44±2.99 d vs.4.89±7.42 d,P=0.028） and postoperative hospital time （10.82±4.31 d vs.14.01±19.30 d,P=0.039） than the PMV group.Furthermore,the SNIV group had lower pneumonia rate （5.26% vs.30.30%,P=0.033） and total postoperative complication rate （10.53% vs.45.45%,P=0.030） than the PMV group.However,there was no significant difference （P〉0.05） between the two groups in the successful weaning rate,repeated tracheal intubation rate,tracheotomy rate and mortality 30 days after operation.After NIV,SNIV group had no significant change in heart rate,central vein pressure,pulmonary arterial pressure and pulmonary arterial wedge pressure than the baseline value,while systolic pressure （129.66±19.11 mm Hg vs.119.01±20.31 mm Hg,P=0.031）,cardiacindex [3.01±0.30 L/（min·m^2） vs.2.78±0.36 L/（min·m^2）,P=0.043] and P/F Ratio （205.95±27.40 mm Hg vs.141.33±9.98 mm Hg,P=0.001） were obviously elevated.Conclusion Sequential NIV is a effective
出处
《中国胸心血管外科临床杂志》
CAS
2010年第3期206-210,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
无创通气
冠状动脉旁路移植术
机械通气
低氧血症
Non-invasive ventilation
Coronary artery bypass grafting
Mechanical ventilation
Hypoxemia
