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目的:探讨无创正压通气序贯治疗急性左心衰合并呼吸衰竭患者的时机选择。方法:选择2013年6月-2015年8月我院收治的120例先行气管插管有创通气治疗的急性左心衰合并呼吸衰竭患者作为研究对象,病情得到控制后,按照拔管时间的长短分为A、B、C 3组,各40例,其中A组在进行自主呼吸30 min后拔管,B组在进行自主呼吸2 h后拔管,C组在进行自主呼吸24 h后拔管,拔管后全部患者均进行无创正压通气序贯治疗,比较3组患者治疗后血气分析结果、呼吸机相关肺炎发生率及脱机成功率。结果:13组患者无创正压通气治疗后的呼吸频率、心率、氧合指数、氧分压、二氧化碳分压及ph值均无明显差异(t1=1.402,t2=1.338,t1=0.738,t2=1.201,t1=0.969,t1=0.857,均P>0.05);2A组患者的脱机成功率为7.50%,显著低于B组的77.50%与C组的82.50%,差异具有统计学意义(P<0.05);A组患者的再插管率为92.50%,显著高于B组的22.50%与C组的17.50%,比较差异具有统计学意义(P<0.05);A组患者的呼吸机相关肺炎发生率为45.00%,显著高于B组的12.50%与C组的10.00%,比较差异具有统计学意义(P<0.05)。结论:急性左心衰合并呼吸衰竭患者在自主呼吸超过2 h后拔管,进行无创正压通气序贯治疗,可明显提高脱机成功率,降低再插管率和呼吸机相关肺炎发生率,值得临床推广。
Objective: To explore the timing of noninvasive positive pressure ventilation in patients with acute left heart failure complicated with respiratory failure. Methods: From June 2013 to August 2015, 120 patients with acute left heart failure complicated with respiratory failure treated with intubation and invasive ventilation in our hospital were selected as the research object. After the condition was controlled, Divided into A, B, C group of 40 cases, of which group A spontaneous breathing after 30 min extubation, spontaneous breathing group B after 2 extubation, C group spontaneous breathing after 24 h extubation After extubation, all patients underwent noninvasive positive pressure ventilation sequential treatment. Blood gas analysis results, ventilator-associated pneumonia and off-line success rates were compared between the three groups. Results: There were no significant differences in respiratory rate, heart rate, oxygenation index, partial pressure of oxygen, partial pressure of carbon dioxide and ph between the 13 groups after noninvasive positive pressure ventilation (t1 = 1.402, t2 = 1.338, t1 = 0.738, t2 = 1.201, t1 = 0.969, t1 = 0.857, all P> 0.05). The success rate of offline in group 2A was 7.50%, which was significantly lower than 77.50% in group B and 82.50% in group C, the difference was statistically significant (P <0.05). The re-intubation rate in group A was 92.50%, significantly higher than that in group B (22.50% vs 17.50% in group C) (P <0.05). The ventilator-related The incidence of pneumonia was 45.00%, significantly higher than 12.50% in group B and 10.00% in group C, with statistical significance (P <0.05). Conclusion: In patients with acute left heart failure complicated with respiratory failure, extubation after spontaneous respiration for more than 2 h followed by noninvasive positive pressure ventilation can significantly improve the success rate of off-line, decrease the rate of reintubation and ventilator-associated pneumonia, Worth clinical promotion.