急性左心衰合并呼吸衰竭拔管后NIPPV序贯治疗时机的研究

目的：探讨急性左心衰竭合并呼吸衰竭患者拔管后采用无创正压通气（ NIPPV）序贯治疗的时机。方法抽选我院60例先行气管插管有创通气治疗的急性左心衰竭合并呼吸衰竭患者，待病情有所控制后，分别以患者自主呼吸试验时间（30 min、2 h和24 h）为气管拔管时机，开始NIPPV序贯治疗，比较各时间点NIPPV序贯治疗后的脱机成功率。结果3组气管插管前MAP、RR、HR、pH以及PaO2、PaCO2指标比较差异无显著性（ P﹥0.05）。30 min组、2 h组和24 h组脱机成功率分别为10％、80％、85％，2 h组和24 h组脱机成功率与30 min组比较差异显著（ P﹤0.05），2 h组和24 h组两组之间比较差异无显著性（ P﹥0.05）。结论急性左心衰合并呼吸衰竭患者当自主呼吸试验时间﹥2 h时，即可拔管予以NIPPV序贯治疗，脱机成功率高，并且不增加48 h再插管率，值得临床推广选择。

Opportunity for NIPPV sequential therapy after extubation in patients with acute left heart failure complicated with respiratory failure

Objective To explore the opportunity for sequential therapy by noninvasive positive pressure ventilation（ NIPPV） after extubation in patients with acute left heart failure complicated with respiratory failure. Methods 60 cases with acute left heart failure complicated with respiratory failure,having been treated by invasive positive pressure ventilation（ IPPV）,were selected;based on the control of the disease,the opportunity for extubation and the NIPPV sequential therapy was fixed at the time point of 30 minutes,2 hours and 24 hours of spontaneous breathing;the successful rates of weaning from the ventilator at each time point after NIPPV were compared. Results There existed no obvious difference in MAP,RR,HR,pH,PaO2 and the PaCO2 index among all the patients before tracheal intubation（P﹥0. 05）;the successful rate of weaning from ventilator at the time point of 30 minutes,2 hours and 24 hours was 10%,80% and 85% respectively;the successful rates at the time point of 2 hours and of 24 hours were significantly different from that at the time point of 30 minutes（P﹤0. 05）,while there was no obvious difference in successful rate between the time point of 2 hours and of 24 hours（ P ﹥0. 05 ）. Conclusions For patients with acute left heart failure complicated with respiratory failure,when spontaneous breathing keeps over 2 hours,extubation can be made and NIPPV sequential therapy be started,which will lead to a high successful rate of weaning from ventilator without increase of re-intubation rate within 48 hours.