摘要
目的观察双水平气道正压通气(BiPAP)治疗冠状动脉旁路移植术后低氧血症的疗效。方法选择236例行冠状动脉旁路移植术拔除气管插管后发生低氧血症患者,采用完全随机设计方法,分为试验组125例和对照组111例。对照组采用常规治疗(持续鼻导管吸氧、抗感染、扩张支气管、化痰、营养支持、镇痛、维护心功能、扩冠、抗凝及维持内环境稳定),试验组在常规治疗的基础上加用BiPAP呼吸机面或鼻罩正压通气治疗,分别于治疗前及使用呼吸机治疗6 h后测定两组患者pH值、动脉血氧分压(PaO_2)、动脉血氧饱和度(SaO_2)和动脉血二氧化碳分压(PaCO_2)等数值,并持续监测呼吸(RR)、心率(HR)、血压(SBP),记录再次气管插管的例数。结果治疗前差异无统计学意义(P>0.05)。治疗6 h后试验组RR[(18.62±1.68)次/min]、HR[(86.45±2.81)次/min]、SBP[(130.32±12.95)mm Hg]、pH值(7.39±0.02)、SaO_2[(95.56±1.19)%]、Pa02[(83.58±4.55)mm Hg]、PaC02[(38.49±3.25)mm Hg],与对照组[RR(23.68±3.69)次/min、HR(102.50±6.68)次/min、SBP(152.60±8.13)mm Hg、pH值(7.35±0.06)、SaO_2(90.97±1.93)%、PaO_2(62.38±6.96)mm Hg、PaCO_2(43.65±2.91)mm Hg]比较,差异均有统计学意义(P<0.05)。试验组患者的缺氧程度明显改善,再次气管插管的病例数低于对照组(P<0.05)。结论 BiPAP是治疗冠状动脉旁路移植术后低氧血症的一种较好的无创通气模式,可减少再次气管插管率。对于术后已经拔除气管插管出现低氧血症的患者,建议早期采用双水平正压无创通气。
Objective To observe the effect of non-invasive bi-level positive pressure ventilation ( BiPAP) on the treatment of hypoxemia after coronary artery bypass ( CAB ) surgery .Methods 236 patients postoperative hypoxemia after CAB surgery were randomly divided into two groups , patients in both groups accepted supportive treatment included cardiotonics,diuretics,vasodilators,in additional to these high concentrations of oxygen were given in conventional group .and non-invasive positive pressure ventilation were given in control group by biphasic positive airway pressure.Systolic blood pressure,heart rate,respiratory rate,blood-gas analysis(pH,PaO2,PaCO2, SaO2)and clinical signs were observed at 6 hours after treatments.Results Compared to control,RR[(18.62 ± 1.68)/min vs.(23.68 ±3.69)/min],HR[(86.45 ±2.81)bpm vs.(102.50 ±6.68)bpm],SBP[(130.32 ± 12.95)mm Hg vs.(152.60 ±8.13 ) mm Hg],pH(7.39 ±0.02 vs.7.35 ±0.06 ),SaO2 [(95.56 ±1.19 )% vs. (90.97 ±1.93)%],PaO2[(83.58 ±4.55)mm Hg vs.(62.38 ±6.96)mm Hg],PaCO2[(38.49 ±3.25)mm Hg vs.(43.65 ±2.91 ) mm Hg] were significantly different in control group .We found no significant difference in the comparisons before treatments .Hypoxia improved in control group .Conclusions BiPAP non-invasive positive pressure ventilation combined with routine treatment in treating hypoxemia after CAB surgery could promptly correct hypoxia ,improve heart function and shortening disease course .
出处
《心血管外科杂志（电子版）》
2013年第4期5-8,共4页
Journal of Cardiovascular Surgery(Electronic Edition)
关键词
正压呼吸
缺氧
冠状动脉旁路移植术
治疗结果
Positive-pressure respiration
Anoxia
Coronary artery bypass
Treatment outcome
