BIPAP用于全身麻醉气管拔管后短期呼吸支持可行性分析

目的：比较和分析BIPAP用于全身麻醉气管拔管后短期呼吸支持的可行性。方法：60例成年择期手术病人随机分为3组（n=20），全麻气管导管拔除后分别予以BIPAP（B组）、CPAP＋PSV（C组）、SIMV＋CPAP（S组）面罩无创机械通气，记录并比较3组予以面罩无创通气后不同时刻血流动力学、血气参数、呼吸参数、并发症发生率及耐受性。结果：（1）3组无创通气后15min血压、心率较基础值明显增加（P＜0．01），S组比B组、C组增加更为明显（P＜0．01），B组、C组在30min以后血流动力学逐渐恢复至基础值，而S组在60分钟时才恢复至无创通气前水平；（2）分钟通气量相同时，B组、C组气道最高压力及平均压低于S组（P＜0．05）、且随无创通气逐渐降低，而S组变化不明显，B组自主呼吸恢复比S组明显（P＜0．05）；（3）3组无创通气后PaO2均显著增加（P＜0．01），PaCO2均在正常生理范围，但S组有升高（P＜0．05）；（4）三组并发症发生率及胃肠减压气体引流量无明显差异（P＞0．05）：（5）B组、C组比S组耐受性更好（P＜0．01）。结论：BIPAP对血流动力学、呼吸功能影响小、允许任何时相的自主呼吸、耐受性良好、并发症少、适用范围广，应用于全身麻醉后短期呼吸支持具有可行性。

Feasibility of Biphasic Intermittent Positive Airway Pressure for Short - term Respiratory Support in Patients Undergoing General Anesthesia after Tracheal Extubation

: To dertermine the feasibility of biphasic intermittent positive airway pressure (BIBAP) for short-term respiratory support in patients undergoing general anesthesia immediately after tracheal extubation. Methods: Sixty adult patients scheduled for operation under general anesthesia were randomly devided into three groups (n =20),in which patients were ventilated with BlPAP(Group B) ,CPAP + PSV(Group C), SIMV + CPAP(Group S) via face mask following tracheal extubation, respectively, Measurements of blood pressure, heart rate, respiratory parameters, arterial blood - gas analyses, complications and tolerance of non-invasive ventilation(NIV),comfort of breathing of patients were recorded. Results: (1) Blood pressure,heart rate in all groups increased 15 minutes after NIV(P<0.01), the most was in Group S (P<0.01), blood pressure and heart rate decreased to basic value at 30 and 60 minutes later in Group B , C and S, respectively. (2)With the same value of Ve.Pmax and Pmean in Group B and C were significantly lower than those in Group S(P<0.05), while Vt was larger than that in Group S(P<0.01) and the restoration of spontaneous breathing in Group B was more obvious than that in Group S(P<0.05). (3)The PaO2 value increased significantly 15 minutes after NIV(P<0. 01) ,and the PaCO2 value was in physiological range, but compared with basic value, there was an increase in S (P<0.01). (4) There was no significant difference among three groups with regard to complications(P>0. 05). (5)Group B and C were generally well tolerated by patients(P< 0. 01). Conclusion: BIPAP is endowed with fewer effects on hemodynamics and respiratory system, allowing unrestricted spontaneous breathing at any moment,fewer complications,better tolerance. The application of BIPAP for short -term respiratory support in patients undergoing general anesthesia after extubation is feasible.