无创呼吸机在呼吸衰竭经鼻气管插管患者的应用

发布时间：2018-11-18 19:59

【摘要】：目的:1.探讨无创呼吸机在呼吸衰竭经鼻气管插管患者行有创机械通气的可行性;2.与常规有创-无创序贯机械通气相比较,拔管前应用无创呼吸机行有创机械通气,拔管后再序贯无创机械通气,两者的脱机成功率、气管插管的保留时间及拔管后无创呼吸机的使用时间有无差异。方法:选择48例因呼吸衰竭行经鼻气管插管有创机械通气的患者,病情稳定,肺部感染基本得到控制,且均有自主呼吸,但是脱机困难。48例患者随机分为A组和B组,24例A组患者改用无创呼吸机连接气管插管行有创机械通气,B组患者继续原有创机械通气,两组患者拔管后均序贯无创机械通气。比较两组患者的脱机成功率、气管插管保留的时间、拔管后无创呼吸机的使用时间;A组患者保留气管插管应用无创呼吸机前后血气分析变化及预后情况。结果:1.A组患者应用无创呼吸机行有创机械通气前后,动脉血气分析p H、Pa O2、Pa CO2、Sa O2无显著差异(P0.05)。2.两组患者的脱机成功率及气管插管保留时间无显著差异、拔管后无创呼吸机的使用时间有显著差异。A组24例患者中22例成功的拔除了气管插管,脱机成功率为91.7%,B组24例患者中21例成功的拔除了气管插管,脱机成功率为87.5%,差异无统计学意义;A组患者气管插管的保留时间为7.79±1.14天,B组患者气管插管的保留时间为7.67±1.93天,差异无统计学意义;A组患者拔管后无创呼吸机的使用时间是4.68±1.64天,B组拔管后无创呼吸机的使用时间是6.45±2.61天,差异有统计学意义(P0.05)。结论:1.在病情稳定,但是脱机困难的呼吸衰竭经鼻气管插管患者,应用无创呼吸行有创机械通气是可行的、有效的。2.呼吸衰竭经鼻气管插管患者,拔管前应用无创呼吸机行有创机械通气,拔除气管插管后再序贯无创机械通气,与常规的有创-无创序贯机械通气相比,脱机成功率及气管插管的保留时间无显著差异,但是拔管后无创呼吸机的应用时间相对缩短。
[Abstract]:Objective: 1. To investigate the feasibility of noninvasive mechanical ventilation in patients with respiratory failure by nasal endotracheal intubation. 2. Compared with conventional invasive and noninvasive sequential mechanical ventilation, noninvasive ventilator was used before extubation and sequential noninvasive mechanical ventilation after extubation was performed. There was no difference in the retention time of tracheal intubation and the use time of non-invasive ventilator after extubation. Methods: Forty-eight patients with respiratory failure underwent naso-tracheal intubation with invasive mechanical ventilation were selected. The patients were in stable condition, pulmonary infection was basically controlled, and all patients had spontaneous respiration, but they had difficulty in weaning. 48 patients were randomly divided into two groups: group A and group B. Twenty-four patients in group A were treated with non-invasive ventilator and tracheal intubation for invasive mechanical ventilation, while patients in group B continued their original invasive mechanical ventilation. Both patients in group A underwent sequential and non-invasive mechanical ventilation after extubation. The success rate of weaning, the time of tracheal intubation retention and the time of using non-invasive ventilator after extubation were compared between the two groups, and the blood gas changes and prognosis of group A were analyzed before and after the application of non-invasive ventilator. Results: 1. There was no significant difference in arterial blood gas analysis between group A and group A before and after non-invasive mechanical ventilation (P0.05). 2. There was no significant difference in the success rate of weaning and the retention time of tracheal intubation between the two groups, but there was a significant difference in the use of non-invasive ventilator after extubation. In group A, 22 cases were successfully removed from tracheal intubation, the success rate was 91.7%. In group B, 21 of 24 patients were successfully removed from tracheal intubation, the success rate of weaning was 87.5, there was no significant difference. The retention time of tracheal intubation in group A was 7.79 卤1.14 days, and that in group B was 7.67 卤1.93 days. The use time of non-invasive ventilator after extubation was 4.68 卤1.64 days in group A and 6.45 卤2.61 days after extubation in group B (P0.05). Conclusion: 1. In patients with respiratory failure with stable condition but difficulty in weaning, it is feasible and effective to use invasive mechanical ventilation in patients with naso-tracheal intubation. In patients with respiratory failure through nasal tracheal intubation, noninvasive mechanical ventilation was performed before extubation, and sequential noninvasive mechanical ventilation after tracheal intubation was removed, compared with conventional invasive and noninvasive sequential mechanical ventilation. There was no significant difference in the success rate of weaning and the retention time of tracheal intubation, but the application time of noninvasive ventilator after extubation was relatively shorter.
【学位授予单位】：南华大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R563.8

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