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|本期目录/Table of Contents|

BiPAP通气治疗OPCAB术后重度低氧血症的效果(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2017年第4期
页码:
443-447
栏目:
临床研究
出版日期:
2017-02-25

文章信息/Info

Title:
Effect of BiPAP Ventilation on the Treatment of Severe Hypoxemic Patients after OPCAB
作者:
何 军1; 罗志强1; 韩 喆1; 柳克晔1; 刘福林1; 贺晓生2
1.河北大学附属医院心脏外科，河北 保定 071002；2.第四军医大学西京医院神经外科，陕西 西安 710032
Author(s):
HE Jun1;  LUO Zhi-qiang1;  HAN Zhe1;  LIU Ke-ye1;  LIU Fu-lin1;  HE Xiao-sheng2
1.Department of Cardiovascular Surgery, Affiliated Hospital of Hebei University, Baoding, 071002, Hebei, China; 2.Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi’an 710032, Shaanxi, China
关键词:
双水平气道内正压通气; 低氧血症; 非体外循环冠脉搭桥术
Keywords:
bi-level positive airway pressure ventilation;  hypoxemia;  Off-pump coronary artery bypass.
分类号:
R543.3
DOI:
-
文献标识码:
A
摘要:
目的 观察无创双水平气道内正压(BiPAP) 通气对非体外循环下冠脉搭桥术（OPCAB）后拔除气管插管后发生重度低氧血症的治疗效果。方法理论回顾性分析2012~2016年在我院行OPCAB，拔除气管插管后发生重度低氧血症68例患者的临床资料。按术后通气方式分为BiPAP组(n=36)和插管组(n=32)。持续观察两组患者的心率(HR)、血压、呼吸频率(RR)，记录心功能分级，血气分析〔包括动脉血氧分压(PaO2)和动脉二氧化碳分压(PaCO2)〕等指标，比较术后并发症。结果 BiPAP组和插管组均可快速、有效提高PaO2，降低PaCO2，改善pH值，两组之间无显著差异。BiPAP组在6 h后可显著降低HR（P<0.01）、平均动脉压（MAP）（P<0.01），并显著降低呼吸机相关肺炎发生（P<0.05），减少ICU停留时间（P<0.01）和术后住院时间（P<0.01）。结论 BiPAP通气安全有效，可以快速改善低氧血症，减少术后并发症。
Abstract:
AIM To observe the therapeutic effect of noninvasive bi-level positive airway pressure (BiPAP) ventilation on severe hypoxemic patients who were removed tracheal intubation after had been performed off-pump coronary artery bypass grafting (OPCAB). METHODS The clinical study included 68 severe hypoxemic patients who were removed of the tracheal intubation after the off-pump coronary artery bypass (OPCAB) surgery in our hospital between 2012 and 2016. All patients were divided into the BiPAP group (n=36) and the tracheal intubation group (n=32) based on postoperative ventilation mode. Physiological data were recorded from all the patients with heart rate (HR), blood pressure (BP), respiration (RR), cardiac functional grading, arterial blood gas analysis- including arterial partial pressure of oxygen (PaO2) and the partial pressure of arterial carbon dioxide (PaCO2). Postoperative complications were also analyzed. RESULTS Both in BiPAP group and tracheal intubation group, the PaO2 was significantly improved, the PaCO2 was decreased and pH was slight increased at the same time. And there were no significant differences in both group. In BiPAP group, HR and mean arterial pressure (MAP) were decreased after 6 hours treatment. Ventilator associated pneumonia (P<0.05), ICU stay time (P<0.01) and the time of hospital stay (P<0.01) were significantly reduced in BiPAP group than in tracheal intubation group. CONCLUSION BiPAP ventilation is a safe and effective treatment, which can quickly improve the level of arterial oxygen pressure and reduce postoperative complications.

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备注/Memo

备注/Memo:
收稿日期：2016-12-02.通讯作者：罗志强，主任医师，主要从事心血管疾病外科治疗研究 Email：lzq0314@126.com 作者简介：何军，主治医师，硕士生 Email：272081569@qq.com
更新日期/Last Update: 1900-01-01