BiPAP在高血压患者深麻醉下拔管后呼吸支持中的应用

目的：探讨双水平气道正压通气（bi-level positive airway pressure ventilation，BiPAP）在高血压患者深麻醉状态下拔管后呼吸支持的临床应用价值。方法：择期行下腹部或全髋置换术的原发性高血压患者40例，随机分为清醒后拔管组（A组，n=20）和深麻醉下拔管组（B组，n=20）。所有患者均采用静脉吸入复合麻醉，主要手术步骤完成后停用吸入麻醉药，仅用静脉麻醉药异丙酚泵注维持麻醉，A组患者术毕即停药，清醒后拔除气管导管。B组患者至拔管前即刻停药，深麻醉状态下拔除气管导管，立即进行BiPAP无创通气。记录拔管前后血压、心率和BIS，BiPAP无创通气过程中动脉血气分析及苏醒期并发症的发生率。结果：A组患者清醒时血压较术前明显升高、心率明显增快（P〈0.01），拔管后较拔管前血压明显升高、心率明显增快（P〈0．05）。B组患者拔管前后血压、心率无明显变化，血气参数基本正常。B组患者舌后坠的发生率明显高于A组患者（P〈0.01），A组患者苏醒期呛咳等并发症要高于B组患者（P〈0．05）。结论：BiPAP适合于高血压患者深麻醉状态下拔管后呼吸支持。

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Objective To evaluate the effect of bi-level positive airway pressure ventilation (BiPAP) for post-extubation respiratory support under deep anesthesia in hypertension patients. Methods Forty primary hypertension patients who were scheduled for lower abdominal surgery or total hip joint replacement were randomly divided into 2 groups: one was extubated when being awake (Group A, n=20), and the other was extubated under deep anesthesia (Group B, n=20). The combined inhalation and the intravenous general anesthesia were performed on all patients, and inhalation anesthesia was maintained with only continued infusion of propofol when major procedure of surgery had been finished. In Group A, anesthesia was ceased when the surgery was finished, and trachea was removed after the patients awoke. In Group B, anesthesia was ceased immediately before the extubation, and trachea was removed under deep anesthesia, followed by an uninvasive ventilation of BiPAP. Blood pressure (BP), heart rate (HR),and bispectral index(BIS) before or after the extubation, artery blood-gass analysis in BIPAP, and the incidence rate of complication in the recovery period were recorded. Results In Group A, BP and HR increased significantly after the patients awoke (P<0.01) and after the extubation (P<0.05), compared with the data before the surgery and before the extubation. In Group B, however, BP and HR had no difference before and after the extubation, and the data of blood gas maintained approximately normal. The incidence rate of glossoptosis in Group B was obviously higher than those in Group A (P< 0.01), while complications such as cough during the recovery stage in Group A were more than those in Group B (P<0.05). Conclusion BiPAP is suitable for post-extubation respiratory support under deep anesthesia in hypertension patients.