摘要
目的探讨无创正压通气(NPPV)不同界面对冠状动脉旁路移植术后低氧血症的干预作用。方法收集2011年9月-2015年1月在我院住院行冠状动脉旁路移植术气管拔管后24 h内发生低氧血症患者46例,按对照原则、随机分为对照组和实验组,各23例;对照组采用面罩进行无创正压通气治疗;实验组采用头罩进行无创正压通气治疗,比较2种界面的通气效果,分别于治疗前(T_0)、治疗1 h(T_1)、治疗6 h(T_2)、治疗结束后(T_3)测定(1)动脉血气(ABG)指标,包括动脉血氧分压[p(O_2)]、动脉二氧化碳分压[p(CO_2)]、血氧饱和度(Sp O_2)、氧合指数[p(O_2)/Fi O_2]等。(2)血液循环指标,包括心率(HR)、平均动脉压(MAP)、左室射血分数(LVEF)等。(3)肝肾功能:包括谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐(Cr)等。记录所有患者NPPV时间、ICU时间及住院时间,记录无创通气期间并发症状况。结果两组患者不同时间点在p(O_2)、p(CO_2)、Sp O_2、p(O_2)/Fi O_2、HR、MAP、LVEF上,存在统计学差异(P<0.05)。与T_0比,两组患者T_1、T_2、T_3时p(O_2)、Sp O_2、p(O_2)/Fi O_2升高,p(CO_2)降低,HR、MAP降低,T_3时LVEF升高(P<0.05);与对照组比,实验组患者T_1、T_2、T_3时p(O_2)、Sp O_2、p(O_2)/Fi O_2较高,p(CO_2)较低,HR、MAP较低,T_3时LVEF较高(P<0.05);与T_0比,对照组患者T_3时AST、Cr升高(P<0.05);对照组NPPV时间、ICU时间及住院时间上显著高于实验组(P<0.05);两组患者胃肠胀气、不耐受比较差异显著(P<0.05)。结论与面罩界面比,头罩界面行NPPV治疗时,可以在短时间内提高p(O_2),降低p(CO_2),改善血液循环状态,且NPPV并发症相对较少,是一种有效的治疗方案。
Objective To investigate the effect of different interfaces of non-invasive positive pressure ventilation on hypoxemia after coronary artery bypass grafting. Methods A total of 46 patients with hypoxemia occurred within 24 hours after tracheal extubation were enrolled in this study.All the patients from September 2011 to January 2015 were divided into 2 groups according to randomized and controlled principle,with 23 cases in per group. The control group was treated with facial mask non-invasive positive pressure ventilation and the experimental group with head mask non-invasive positive pressure ventilation treatment. The ventilation effects of the two groups were compared,and arterial blood gas（ ABG） including arterial oxygen partial pressure [p（ O2） ],arterial carbon dioxide partial pressure [p（ CO2） ],oxygen saturation（ Sp O2）,oxygenation index [p（ O2）/Fi O2],blood circulation parameters,including heart rate（ HR）,mean arterial pressure（ MAP）,left ventricular ejection fraction（ LVEF） and so on,and liver and kidney function including alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,creatinine（ Cr） were measured before treatment（ T0）,at 3 h（ T1）,6 h（ T2） of treatment and after treatment（ T3）. NPPV time,ICU time and length of stay time,complications during non-invasive ventilation were recorded. Results There were significant differences in p（ O2）,p（ CO2）,Sp O2,p（ O2）/Fi O2,HR,MAP and LVEF at different time points（ P〈0. 0 5）. Compared with T0,p（ O2）,Sp O2,p（ O2）/Fi O2 increased,p（ CO2） decreased,HR and MAP decreased,and LVEF increased at T3（ P〈0. 05）. Compared with control group,the experimental group had higher p（ O2）,Sp O2,p（ O2）/Fi O2 at T1,T2 and T3,p（ CO2） was lower,HR and MAP were lower,LVEF and AST,Cr were higher at T3（ P〈0. 05）. The NPPV time,ICU time and hospitalization time in the control group were higher than that in the experimental group（ P〈0. 05）. There was significant difference between the two groups in the flatulence and intolerance of the stomach（ P〈0. 05）. Conclusion Compared with the interface of facial mask,NPPV can improve p（ O2）,decrease p（ CO2）,improve blood circulation,and have relatively few NPPV complications,so is an effective treatment.
作者
王兆东
WANG Zhaodong(Department of Cardiac Surgery, Qingdao Sida Cardiac Hospital, Qingdao , Shandong, 26600)
出处
《实用临床医药杂志》
CAS
2017年第17期99-102,105,共5页
Journal of Clinical Medicine in Practice
基金
山东省卫计委科研计划项目(2013WS2761)
关键词
面罩界面
头罩界面
无创正压通气
冠状动脉旁路移植术
低氧血症
facial mask interface
head mask interface
non-invasive positive pressure ventilation
coronary artery bypass grafting
hypoxemia
