头罩持续气道内正压治疗体外循环心脏手术拔除气管插管后低氧血症初探

目的总结头罩持续气道内正压(CPAP)无创通气治疗体外循环(CPB)心脏手术拔除气管插管后低氧血症的临床疗效。方法分析2013年12月至2014年3月期间,CPB下开胸心脏外科手术入ICU监护的接受头罩CPAP治疗6例患者的临床资料。患者拔除气管插管后48 h内出现低氧血症,面罩给氧氧合指数(PaO2/FiO2)无法达到200以上开始头罩治疗,疗程为6 h;采用自身对照比较治疗前中后各项参数。结果头罩CPAP治疗3 h,患者的PaO2和PaO2/FiO2明显提升[(76.84±8.93)mmHg vs.(150.44±56.05)mmHg和(153.30±15.79)vs.(255.20±76.05),P0.05],其他各项血气指标及治疗结束后和治疗时血气指标之间的变化不明显。呼吸频率和心率明显降低[(32.33±2.42)次/min vs.(21.33±5.98)次/min和(108.40±25.60)次/min vs.(98.20±33.54)次/min,P0.05),治疗后与治疗时无明显差异。结论头罩CPAP治疗明显提升拔除气管插管后出现低氧血症患者的PaO2和PaO2/FiO2,对心功能有一定辅助作用。

Preliminary exploration of CPAP-Helmet treatment for hypoxemia in airway extubated patients after cardiac surgery with cardiopulmonary bypass

Objective To summary the clinical efficacy of the continuous positive airway pressure （CPAP）-Helmet for the treatment of hypoxemia in airway extubated patients after cardiac surgery with cardiopulmonary bypass （CPB）.Methods The clinical data of 6 adult patients in ICU from December 2013 to March 2014,who were after open heart surgery with CPB,were collected.These patients suffered hypoxemia within 48 hours after extubation,and their PaO2/FiO2 with oxygen mask could not reach more than 200.Treatment duration was six hours.Paired t test was used for compare.Results Three hours of the CPAP-Helmet therapy significantly improved the patient＇s PaO2 and PaO2/FiO2（76.84±8.93 vs.150.44±56.05 mmHg and 153.30±15.79 vs.255.20±76.05,P ＜0.05 respectively）.Other indicators of blood gas during the treatment and after the treatment were not changed obviously.Respiratory rate and heart rate were significantly lower with the treatment （32.33±2.42 vs.21.33±5.98 beats/min and 108.40±25.60 vs.98.20±33.54 times/min,P ＜0.05 respectively）,while no significant differences during the treatment and after the treatment were found.Conclusion The CPAP-Helmet therapy improves PaO2 and PaO2/FiO2 significantly in patients with hypoxemia after airway extubation,who had underwent cardiac surgery with CPB.CPAP-Helmet plays a role in supporting cardiac function.