摘要
目的评价无创机械通气（NIV）对腹部手术后低氧性呼吸衰竭患者气管再插管的影响。方法选取在我院ICU治疗的348例腹部手术后7d内发生低氧性呼吸衰竭的患者，根据随机数字表法，将患者分为两组，即接受NIV治疗组（NIV组，n=173）和标准氧治疗组（标准氧疗组，n=175），治疗从完成随机分组开始共进行30d或至离开ICU止。比较两组患者气管再插管率、无创通气时间、治疗相关感染发生率与病死率。结果NIV组患者7d内再次插管发生率明显低于标准氧疗组[57（32．9％）VS．80（45．7％），X^2=5．940，P=0．015]；与标准氧疗组比较，NIV组患者无创通气时间明显提高[（25．5±4．2）dvs．（20．6±3．8）d，t=11．415，P〈0．001]，NIV组患者30d内感染发生率更低[54（31．2％）vs．86（49．1％），x^2=11．630，P〈0．001]，NIV组患者7d内[17（9．8％）VS．39（22．3％），x^2=10．002，P=0．002]与30d内[25（14．5％）VS．52（29．7％），x^2=11．763，P〈0．001]肺炎发生率更低。两组患者ICU住院时间与病死率比较差异无统计学意义（均P〉0．05）。多变量分析表明，NIV与患者气管再插管负相关（OR=0．496，95％CI 0．231—0．817，P=0．007）。结论与标准氧疗比较，NIV能降低腹部手术后低氧性呼吸衰竭患者术后气管插管的风险。
Objective To evaluate the effect of noninvasive ventilation （NIV） on endotracheal reintubation in patients with hypoxic respiratory failure after abdominal surgery. Methods The patients with hypoxic respiratory failure within 7 days after abdominal surgery in our hospital ICU were randomly divided into two groups according to the random number table method. The patients were treated with NIV （NIV group, n = 173 ） treatment or standard oxygen treatment （standard oxygen therapy group, n = 175 ）. The treatment was performed for 30 days from completion of randomization, or to leave ICU. The endotracheal reintubation rate, noninvasive ventilation time, treatment - related infection and mortality were compared between the two groups. Results The number of patients endotraeheal re - intubated in the NIV group was significantly lower than that in the standard oxygen therapy group [ 57 （32.9%） vs. 80 （45.7%） , X^2 = 5. 940, P = 0. 015 ]. Compared with the standard oxygen therapy group, the NIV group had no significant improvement in noninvasive ventilation time [ （ 25.5 ± 4.2 ） d vs. （20.6 ±3.8） d, t =11.415, P〈0.001]. The patients in the NIV group had fewer infections[54 （31.2% ） vs. 86 （49. 1% ） , X^2 = 11. 630, P 〈 0. 001 ]. The patients in group NIV had fewer patients with pneumonia within 7 days [ 17 （9.8%） vs. 39 （22.3%）, X2 = 10. 002, P =0.002 ] and 30 days [25 （14.5%） vs. 52 （29.7%）, X^2 = 11. 763, P 〈 0. 001 ]. There was no statistically significant difference in ICU hospitalization time between the two groups （ P 〉 0.05 ）. Multivariate analysis showed that NIV was negatively correlated with endotracheal reintubation （OR = 0. 496, 95% CI 0. 231 - 0.817, P = 0. 007 ）. Conclusion Noninvasive ventilation can reduce the risk of endotracheal reintubation in patients with hypoxic respiratory failure after abdominal surgery compared with standard oxygen therapy.
出处
《中国急救医学》
CAS
CSCD
北大核心
2017年第11期1011-1015,共5页
Chinese Journal of Critical Care Medicine
基金
天津卫生局科技基金（2015KTA）01）
关键词
无创机械通气(NIV)
气管再插管
呼吸衰竭
Noninvasive ventilation（NIV）
Endotracheal reintubation
Respiratory failure
