标题：急性左心衰合并Ⅱ型呼吸衰竭患者的NIPPV序贯治疗时机探讨

      作者：姜俊广，王海波，陈树伟
    (中国人民解放军第107医院胃肠外科，山东 烟台 264002)

      卷次： 2015年26卷15期

      【摘要】 目的 探讨有创通气治疗急性左心衰合并Ⅱ型呼吸衰竭患者采用无创正压通气(NIPPV)序贯治疗
的时机。方法 选取本院2012年12月至2014年12月收治的92例先行气管插管有创通气治疗的急性左心衰竭
合并Ⅱ型呼吸衰竭患者为研究对象，所有患者按自主呼吸试验的时间长短分为三组，A组30例在自主呼吸试验
时间 30 min拔管，B组 31例在 2 h后拔管，C组 31例在 24 h后进行拔管。所有患者均在拔管后开始NIPPV序
贯治疗，观察比较不同时间点NIPPV序贯治疗后的脱机成功率、呼吸机相关肺炎(VAP)发生率和血气分析结
果。结果 三组患者脱机成功率分别为10.00%、80.65%、83.87%，B组和C组脱机成功率明显高于A组，差异均
有统计学意义(P<0.05)，而B组和C组相似，差异无统计学意义(P>0.05)；A组患者VAP发生率为43.33%，明显高
于B组的12.90%、C组的9.68%，差异均有统计学意义(P<0.05)；血气分析结果发现，三组患者接受无创通气后的
pH值、氧分压、二氧化碳分压、氧合指数、心率、呼吸频率与拔管时比较差异均无统计学意义(P>0.05)。结论 自
主呼吸试验时间>2 h时，呼吸衰竭患者可拔管予以NIPPV序贯治疗，其脱机成功率高，且可降低48 h再插管率，
值得临床推广。

      【关键词】 有创通气治疗；左心衰；呼吸衰竭；无创正压通气

      【中图分类号】 R541.6 【文献标识码】 A 【文章编号】 1003—6350（2015）15—2196—03


Investigation on the timing of noninvasive positive pressure ventilation as sequential therapy in the treatment of
patients with acute left heart failure complicating type Ⅱ respiratory failure.
JIANG Jun-guang, WANG Hai-bo,
CHEN Shu-wei. Department of Gastrointestinal Surgery, the 107th Hospital of Chinese People's Liberation Army, Yantai
264002, Shandong, CHINA

【Abstract】 Objective To investigate the timing of noninvasive positive pressure ventilation (NIPPV) as se-
quential therapy during invasive ventilation for patients with acute left heart failure complicating type Ⅱ respiratory
failure. Methods Ninety-two patients who underwent invasive ventilation for acute left ventricular failure complicat-
ed with typeⅡ respiratory failure from December 2012 to December 2014 in our hospital were enrolled in the study.
According to the time of spontaneous breathing trial, the patients were divided into three groups: group A (30 cases,
underwent extubation 30 min after spontaneous breathing trial), group B (31 cases, underwent extubation 2 h after
spontaneous breathing trial), group C (31 cases, underwent extubation 24 h after spontaneous breathing trial). All pa-
tients received NIPPV after extubation as sequential therapy. The success rate of weaning from the ventilator, the inci-
dence of ventilator associated pneumonia (VAP), blood gas analysis results were compared at different time points af-
ter NIPPV. Results The success rate of weaning from the ventilator were 10.00%, 80.65%, 83.87% in group A, B, C,
respectively. The rates in group B and group C were significantly higher than that in group A (P<0.05), while the rates
in group B and C showed no statistically significant difference (P>0.05). The incidence of VAP was 43.33% in group
A, significantly higher than 12.90% in group B and 9.68% in group C (P<0.05). Blood gas analysis showed that there
was no statistically significant difference in all the three groups in pH value, the partial pressure of oxygen, partial
pressure of carbon dioxide, oxygenation index, heart rate, respiratory rate between after NIPPV and at extubation (P>
0.05). Conclusion For patients with acute left heart failure complicating typeⅡ respiratory failure, when spontane-
ous breathing keeps over 2 hours, extubation can be made and NIPPV sequential therapy can started, which will lead
to a higher successful rate of weaning from ventilator without increase of re-intubation rate within 48 hours．

      【Key words】 Invasive ventilation therapy; Left heart failure; Respiratory failure; Noninvasive positive pres-
sure ventilation (NIPPV)
基金项目：国家高技术研究与发展计划项目（863计划，编号：2012AA020206）