摘要
目的:探讨肥胖患者脱机拔管后序贯无创正压通气(NPPV)的临床价值。方法:选择2014-02-2017-04期间在我院重症监护室(ICU)住院准备脱机拔管的肥胖患者为研究对象,随机分为对照组(32例)及观察组(32例)。对照组脱机拔管后按传统方法行鼻导管吸氧,观察组脱机拔管后予以序贯NPPV至少6h后适时改为鼻导管吸氧。比较分析两组患者的年龄,性别,病种,APACHEⅡ评分,拔管前及拔管后1、6、24h的心率(HR)、血压(BP)、呼吸频率(f)、血氧饱和度(SPO_2)、pH值、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2),拔管前及拔管后24h的N-端脑钠肽前体(NT-ProBNP)水平,ICU住院时间,机械通气时间,拔管后ICU住院时间,拔管失败率,再机械通气时间的差异。结果:(1)两组患者在年龄、性别、病种、APACHEⅡ评分差异无统计学意义;(2)两组患者拔管前的HR、BP、f、SPO_2、pH值、PaO_2、PaCO_2、NT-ProBNP水平差异无统计学意义;(3)与对照组相比,观察组拔管后1h、6h、24h的HR、BP、f、PaCO_2及拔管后24h的NT-ProBNP水平更低,SPO_2、pH值、PaO_2更高,差异有统计学意义(P<0.05);(4)与对照组相比,观察组的拔管失败率更低,ICU住院时间、机械通气时间、拔管后ICU住院时间、再机械通气时间更短,差异有统计学意义(P<0.05)。结论:肥胖患者脱机拔管后序贯NPPV能明显改善其通气功能、减轻心脏负荷、降低呼吸功和氧耗,从而降低拔管失败率及缩短ICU住院时间,有较好的临床实用价值。
Objective： To investigate the clinical value of sequential non-invasive positive pressure ventilation （NPPV） after weaning from obese patients. Method： Choose obese patients admitted to our ICU from 2014. 2- 2017.4 who were going to wean from ventilator. They were randomly divided into control group （n= 32） and observation group （n= 32）. The control group received the nasal catheter oxygen inhalation. The patients in the observation group received sequential NPPV at least 6 hours after the extubation,and then change to nasal catheter oxygen inhalation. We analyze the differences of two groups of patients with age,sex,disease,APACHE Ⅱ score, the heart rate （ HR）, blood pressure （BP）, respiratory rate （f）, oxygen saturation （SPO2）, pH, arterial oxygen partial pressure （PaO2） and arterial carbon dioxide pressure （PaCO2） before and after 1 hours,6 hours,24 hours from extubation,the level of N-end brain natriuretic peptide （NT-ProBNP） before and after 24 hours from extubation were recorded,the time spent in ICU,mechanical ventilation time, the time spent in ICU after extubation, extubation failure rate and the time of remechanical ventilation. Result：OThere was no significant difference between the two groups in age, gender, disease type and APACHE ]][ score ; ①The HR, BP, F, SPO2 , pH, PaO2, PaCO2 and NT- ProBNP levels before extubation were not significantly different between the two groups;②Compared with the control group,the observation group had a lower level of HR, BP, f, PaCO2 after 1 hours, 6 hours, 24 hours from extubation and a lower level of NT-ProBNP after 24 hours from extubation,but a higher level of SPO2 .pH.PaO2 after 1 hours, 6 hours,24 hours from extubation （P〈0.05） ;③Compared with the control group, the observation group had a lower rate of extubation failure, a shorter time spent in ICU, mechanical ventilation time, ICU time after extubation and time of re-mechanical ventilation （P〈0.05）. Conclusion： A sequential NPPV after extubat
出处
《临床急诊杂志》
CAS
2017年第10期740-743,共4页
Journal of Clinical Emergency
关键词
肥胖
机械通气
脱机拔管
序贯无创正压通气
obesity
mechanical ventilation
extubation
sequential non-invasive positive pressure ventilation
