无创正压通气在心脏手术后急性左心衰竭患者的应用

目的:观察无创正压通气(NPPV)治疗心脏手术后,急性左心衰竭患者的临床疗效。方法:分析2012年7月至2013年6月期间,56例非体外冠状动脉旁路移植(OPCABG)术后发生急性左心衰竭的患者的临床资料,其中男性39例,女性17例,年龄48~65岁,平均年龄(57±5)岁。患者被随机分为对照组(28例)及NPPV组(28例),对照组给予常规治疗并辅以高浓度氧气吸入;NPPV组患者常规治疗同时应用无创正压通气治疗。比较两组患者治疗前后心率(HR)、呼吸频率(RR)、血乳酸(Lac)、动脉血气等以及二次气管插管、监护室停留时间等指标的变化。结果:对照组中1例患者因大面积脑梗死死亡,其余患者均存活出院。NPPV组中1例患者因无法耐受无创正压通气转为有创机械通气,1例因治疗失败二次插管;NPPV组患者二次气管插管[(2)vs.(12)例,P=0.001]及监护室停留时间[(4.3±1.1)vs.(7.3±1.5)h,P0.001]明显少于对照组;两组患者治疗后各指标明显好于治疗前,NPPV组改善较对照组更为显著。结论:NPPV可以明显改善OPCABG术后左心衰竭患者的缺氧状况,降低二次气管插管的概率,缩短监护室停留时间。

Clinical application of non-invasive positive pressure ventilation in patients with acute left ventricular failure after cardiac surgery

Objective：To evaluate the effects of non-invasive positive pressure ventilation （NPPV） in patients with acute left ventricular failure after off-pump coronary artery bypass grafting （OPCABG）.Methods：From July 2012 to June 2013,56 patients with acute left ventricular failure after OPCABG were enrolled,of which 39 were male,seventeen were female,the mean age was 57 （48-65） years.The 56 patients were randomly divided into two groups：control group and NPPV group.28 patients in the control group were given routine treatment with high level of oxygen concentration; 28 patients in the NPPV group were treated by NPPV plus routine treatment.Physiological measurements and clinical parameters,such as heart rate （HR）,respiratory rate （RR）,the lever of blood lactate （Lac）,arterial blood gas parameters,the duration of tracheal intubation and ICU stay,were observed and compared between the two groups.Results：55 patients were survived and discharged; one patient in the control group died due to massive cerebral infarction.Two patients in the NPPV group were re-intubated and invasively ventilated,one patient required invasive mechanical ventilation due to the intolerance of NPPV,the other failed in NPPV.Compared with the control group,the ratio of re-intubation in the NPPV group was much lower [（12） vs.（2） cases,P =0.001] ; the duration of ICU stay in the NPPV group （7.3 ± 1.5）h was significantly shorter than that of the control group [（4.3 ± 1.1）h,P ＜0.001].All physiological measurements and clinical parameters in the two groups were improved after treatments.The improvements of the NPPV group were more significant.Conclusion：NPPV obviously improves the oxygenation in patients with acute left ventricular failure after OPCABG,and may avoid the need for endotracheal intubation and shorten the duration of ICU stay in this population.