间断双水平气道内正压通气在气管插管拔除后的临床应用价值研究

目的 探讨间断双水平气道内正压通气在气管插管拔除后的临床应用价值.方法 64例因各种原因行气管插管后,经系统治疗后达到拔除气管插管条件的患者予拔除气管插管,然后分为常规吸氧组和无创通气组.常规吸氧组31例,给予持续低浓度鼻导管吸氧;无创通气组33例,应用间断双水平气道内正压通气(每天4次,每次3 h).观察比较两组患者治疗后12 h、24 h与48 h的动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血pH值和再插管率,并对结果进行统计分析.结果 无创通气组治疗后12 h、24 h与48 h的PaO_2分别为(75.06±6.19)mm Hg、(74.90±8.62)mm Hg、(73.88±9.46)mm Hg,均高于常规吸氧组[(69.77±7.08)mm Hg、(68.74±7.08)mm Hg、(67.19±10.12)mm Hg,P<0.05].无创通气组治疗后12 h、24 h与48 h的PaCO_2分别为(38.33±5.25)mm Hg、(39.00±6.02)mm Hg、(40.91±8.08)mm Hg,均低于常规吸氧组[(41.74±4.56)mm Hg、(43.52±7.45)mm Hg、(45.77±8.95)mm Hg,P<0.05].两组治疗后12 h、24 h与48 h的pH值差异均无统计学意义.无创通气组治疗后48 h的再插管率低于常规吸氧组(9.09%vs 29.03%,P<0.05).而治疗后12 h、24 h的再插管率比较两组间差异均无统计学意义(3.03%vs 6.45%,6.06%vs 12.90%).结论 间断双水平气道内正压通气应用于气管插管拔除后的患者,可提高其PaO_2,减少二氧化碳的潴留,应用48 h后可降低再插管率.

Study on clinical application of intermittent bi-level positive airway pressure after removal of endotracheallntubation

Objective To approach the clinical application of intermittent bi-level positive airway pressure (BiPAP) after removal of endotracheal intuhation. Methods After removal of endotracheal intubation, sixty-four patients were divided into conventional treatment group (31 cases) and BiPAP group (33 cases). Conventional treatment group received low level oxygen continously, and BiPAP group received BiPAP intermittently. The arterial blood analysis and the reintubation rate after 12 hours, 24 hours and 48 hours of therapy were compared between the two groups. Results PaO_2 in BiPAP group was higher than that in conventional treatment group after 12 hours, 24 hours and 48 hours of therapy, (75.06±6.19) mm Hg vs (69.77±7.08) mm Hg,(74.90±8.62) mm Hg vs (68.74±7.08) mm Hg, (73.88±9.46) mm Hg vs (67.19±10.12)mm Hg (all P<0.05). PaCO_2 in BiPAP group was lower than that in conventional treatment group after 12 hours,24 hours and 48 hours of therapy, (38.33±5.25) mm Hg vs (41.74±4.56) mm Hg,(39.00±6.02) mm Hg vs (43.52±7.45) mm Hg,(40.91±8.08) mm Hg vs(45.77±8.95) mm Hg (all P <0.05). But there was no statistical difference on pH value between the two groups. The reintubation rate in BiPAP group was lower than that in conventional treatment group after 48 hours of therapy,(9.09% vs 29.03%, P <0.05). There was no statistical difference on reintubation rate between the two groups after 12 hours and 24 hours of therapy (3.03% vs 6.45%, 6.06% vs 12.90 %. Conclusions For patients after removal of endotraeheal intubation,intermittent BiPAP can improve PaO_2 ,decrease PaCO_2, and reduce reintubation rate after 48 hours of therapy.