2018 年第 5 期 第 13 卷

双水平正压通气治疗非体外循环冠状动脉旁路移植术后严重低氧血症的临床效果

Therapeutic effect of bilevel positive airway pressure ventilation on severe hypoxemia after off-pump coronary artery bypass grafting

作者：党海明宋邦荣董然

英文作者：

单位：100029首都医科大学附属北京安贞医院心脏外科

英文单位：

关键词：非体外循环冠状动脉旁路移植术；双水平正压通气；低氧血症

英文关键词：

• 摘要：

• 目的    观察双水平正压通气治疗非体外循环冠状动脉旁路移植术后严重低氧血症的临床效果。方法    选择2016年6月至2017年12月首都医科大学附属北京安贞医院收治的经其他机械通气模式治疗无效的非体外循环冠状动脉旁路移植术后严重低氧血症患者41例，所有患者均应用PB840呼吸机的双水平正压通气模式进行呼吸治疗。观察应用双水平正压通气模式治疗前及治疗4、12 h后的氧合指数、动脉血二氧化碳分压、呼吸频率、心率、平均动脉压等指标的变化，并记录治疗期间不良反应发生情况。结果    本组患者经治疗全部脱离呼吸机。应用双水平正压通气模式治疗4 h后患者氧合指数、动脉血二氧化碳分压明显高于治疗前［（166±22）mmHg(1 mmHg=0.133 kPa)比（149±18）mmHg、（32±5）mmHg比（28±3）mmHg］，呼吸频率、平均动脉压明显低于治疗前［（28±4）次/min比（33±4）次/min、（90±6）mmHg比（96±8）mmHg］，差异均有统计学意义（均P＜0.01）。治疗12 h后，患者氧合指数、动脉血二氧化碳分压明显高于治疗前和治疗4 h后，呼吸频率、心率明显低于治疗前和治疗4 h后，平均动脉压明显低于治疗前，差异均有统计学意义（均P＜0.01）。治疗过程中患者与呼吸机同步性良好，未发生循环不稳定、气胸、冠状动脉痉挛等不良事件。结论    双水平正压通气模式是治疗非体外循环冠状动脉旁路移植术后严重低氧血症的有效方法，应注意调整参数以达到最佳同步性并减少并发症。

• 【Abstract】Objective    To observe the therapeutic effect of bilevel positive airway pressure ventilation on severe hypoxemia after off-pump coronary artery bypass grafting（OPCABG）. Methods    From June 2016 to December 2017, 41 patients with severe hypoxemia after OPCABG who were refractory to other modes of mechanical ventilation respiratory therapy were enrolled in Beijing Anzhen Hospital, Capital Medical University to have bilevel positive airway pressure ventilation with the PB840 respirator. Oxygenation index, arterial partial pressure of carbon dioxide, respiratory rate, heart rate and mean arterial pressure were recorded before and 4, 12 h after bilevel ventilation. Results    All patients were successfully weaned from respiratory support after ventilation therapy. Oxygenation index and arterial partial pressure of carbon dioxide 4 h after therapy were significantly higher than those before therapy［（166±22）mmHg vs（149±18）mmHg, （32±5）mmHg vs（28±3）mmHg］; respiratory rate and mean arterial blood pressure 4 h after therapy were significantly lower than those before therapy［（28±4）times/min vs （33±4）times/min, （90±6）mmHg vs （96±8）mmHg］（all P＜0.01）. Oxygenation index and arterial partial pressure of carbon dioxide 12 h after therapy were significantly higher, respiratory rate and heart rate were significantly lower than those before therapy and those 4 h after therapy; mean arterial blood pressure 12 h after therapy was significantly lower than that before therapy（all P＜0.01）. No adverse events such as circulation instability, pneumothorax and coronary spasm were observed. Conclusion    Bilevel positive airway pressure ventilation is effective in treatment of severe hypoxemia after OPCABG.

  【Key words】Off-pump coronary artery bypass；Bilevel positive airway pressure ventilation；Hypoxemia

  【Fund program】National Natural Science Foundation of China (81570373)