【摘要】：目的:1.探討無(wú)創(chuàng)呼吸機(jī)在呼吸衰竭經(jīng)鼻氣管插管患者行有創(chuàng)機(jī)械通氣的可行性;2.與常規(guī)有創(chuàng)-無(wú)創(chuàng)序貫機(jī)械通氣相比較,拔管前應(yīng)用無(wú)創(chuàng)呼吸機(jī)行有創(chuàng)機(jī)械通氣,拔管后再序貫無(wú)創(chuàng)機(jī)械通氣,兩者的脫機(jī)成功率、氣管插管的保留時(shí)間及拔管后無(wú)創(chuàng)呼吸機(jī)的使用時(shí)間有無(wú)差異。方法:選擇48例因呼吸衰竭行經(jīng)鼻氣管插管有創(chuàng)機(jī)械通氣的患者,病情穩(wěn)定,肺部感染基本得到控制,且均有自主呼吸,但是脫機(jī)困難。48例患者隨機(jī)分為A組和B組,24例A組患者改用無(wú)創(chuàng)呼吸機(jī)連接氣管插管行有創(chuàng)機(jī)械通氣,B組患者繼續(xù)原有創(chuàng)機(jī)械通氣,兩組患者拔管后均序貫無(wú)創(chuàng)機(jī)械通氣。比較兩組患者的脫機(jī)成功率、氣管插管保留的時(shí)間、拔管后無(wú)創(chuàng)呼吸機(jī)的使用時(shí)間;A組患者保留氣管插管應(yīng)用無(wú)創(chuàng)呼吸機(jī)前后血?dú)夥治鲎兓邦A(yù)后情況。結(jié)果:1.A組患者應(yīng)用無(wú)創(chuàng)呼吸機(jī)行有創(chuàng)機(jī)械通氣前后,動(dòng)脈血?dú)夥治鰌 H、Pa O2、Pa CO2、Sa O2無(wú)顯著差異(P0.05)。2.兩組患者的脫機(jī)成功率及氣管插管保留時(shí)間無(wú)顯著差異、拔管后無(wú)創(chuàng)呼吸機(jī)的使用時(shí)間有顯著差異。A組24例患者中22例成功的拔除了氣管插管,脫機(jī)成功率為91.7%,B組24例患者中21例成功的拔除了氣管插管,脫機(jī)成功率為87.5%,差異無(wú)統(tǒng)計(jì)學(xué)意義;A組患者氣管插管的保留時(shí)間為7.79±1.14天,B組患者氣管插管的保留時(shí)間為7.67±1.93天,差異無(wú)統(tǒng)計(jì)學(xué)意義;A組患者拔管后無(wú)創(chuàng)呼吸機(jī)的使用時(shí)間是4.68±1.64天,B組拔管后無(wú)創(chuàng)呼吸機(jī)的使用時(shí)間是6.45±2.61天,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:1.在病情穩(wěn)定,但是脫機(jī)困難的呼吸衰竭經(jīng)鼻氣管插管患者,應(yīng)用無(wú)創(chuàng)呼吸行有創(chuàng)機(jī)械通氣是可行的、有效的。2.呼吸衰竭經(jīng)鼻氣管插管患者,拔管前應(yīng)用無(wú)創(chuàng)呼吸機(jī)行有創(chuàng)機(jī)械通氣,拔除氣管插管后再序貫無(wú)創(chuàng)機(jī)械通氣,與常規(guī)的有創(chuàng)-無(wú)創(chuàng)序貫機(jī)械通氣相比,脫機(jī)成功率及氣管插管的保留時(shí)間無(wú)顯著差異,但是拔管后無(wú)創(chuàng)呼吸機(jī)的應(yīng)用時(shí)間相對(duì)縮短。
[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 鹵1.14 days, and that in group B was 7.67 鹵1.93 days. The use time of non-invasive ventilator after extubation was 4.68 鹵1.64 days in group A and 6.45 鹵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.
【學(xué)位授予單位】：南華大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R563.8

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