无创正压通气在肾移植后重症肺炎患者中的应用效果观察

目的探讨无创正压通气（NIPPV）在肾移植后重症肺炎患者中的疗效。方法回顾性分析22例肾移植后重症肺炎患者使用无创正压通气后呼吸功能及血流动力学变化情况、疾病预后及不良反应等。结果22例患者实施了NIPPV，19例患者初始通气成功，但其中12例患者中转气管插管有创通气；无创通气后2小时，成功无创通气患者的氧合指数（PaO2／FiO2）（189．7±64．5）mmHg较通气前（148．6±45．7）mmHg明显增高，P〈0．05，且随时间不断增加；呼吸频率（RR）、心率（FIR）、平均动脉压（MAP）也均较通气前明显改善（P〈0．05）；初始接受无创通气患者病死率为57．9％，所有接受有创通气患者病死率为93．3％，总病死率为68。2％；无创通气患者中发生胃胀气3例，面部溃疡1例。结论无创正压通气可以改善早期肾移植后重症肺炎患者的氧合功能，并降低病死率，并发症较少。

The observation of application of noninvasive intermittent positive pressure ventilation in patients with severe pneumonia after kidney transplantaion

Objective To investigate the effect of noninvasive intermittent positive pressure ventilation on the patients with severe pneumonia after renal transplantation. Methods The parameters of 22 patients with severe pneumonia after renal transplantation including the ratio of partial pressure of oxygen in artery to fraction of inspiratory oxygen （PaO2/FiO2）, heart rate （HR）, mean arterial pressure（MAP）, respiratory rate（RR）, and partial pressure of carbon dioxide（PaCO2） during pre- and post-NIPPV, the prognosis, and complications were analyzed retrospectively. Results NIPPV was implemented in 22 patients. Nineteen patients were ventilated successfully primarily. Twelve patients were halfway switched to endotracheal intubation and invasive ventilation. PaO2/FiO2 of the patients achieving NIPPV was increased significantly after two hours of NIPPV （ 189.7 ± 64.5）mmHg vs （ 148.6± 45.7）mmHg, P 〈 0.05 ] and was increased gradually by the time. HR, MAP, RR, and PaCO2 were ameliorated. The mortality of the patients with NIPPV was 57.9%. The mortality of the patients with invasive ventilation was 93.3 %. The total mortality of all patients was 68.2 %. Among the patients of NIPPV, there were 3 gastric insufflations and 1 skin ulcer. Conclusion NIPPV oould improved the poor oxygenation of the patients with severe pneumonia after renal transplantation in the early stage with few complications and reduce the mortality.