冠状动脉旁路移植术后撤机困难的序贯通气治疗 - 第三军医大学学报.doc

冠状动脉旁路移植术后撤机困难的序贯通气治疗 程智广，杨传瑞，李大连，郭建中，高翔，杨峰 （首都医科大学附属北京友谊医院 心脏中心 心脏外科，北京 100050）。无创通气；呼吸功能衰竭；冠状动脉旁路移植术中图分类号：R 654.2 文献标识码：AInvasive-noninvasive sequential ventilation for extubation failure after coronary artery bypass surgery CHENG Zhi-guang, YANG Chuan-rui, LI Da-lian, GUO Jian-zhong, GAO Xiang，YANG Feng(Department of Cardiac Surgery，Beijing Friendship Hospital Affiliated to Capital Medical University, Beijing 100050, China) Objective This study aims to assess whether the application of non-invasive positive pressure ventilation can correct impediments of weaning from mechanical ventilation in those patients who failed to be extubated after coronary artery bypass surgery. Methods 360 patients undergoing coronary artery bypass surgery were included in the study during December 2005 to February 2010. Those patients were divided into non-invasive positive pressure ventilation group (N group, n=21) and control group (C group, n=329). During non-invasive positive pressure ventilation, mean arterial pressure, heart rate ,respiratory rate, arterial pH, arterial oxygen saturation, pulmonary arterial wedge pressure, arterial carbondioxide saturation, arterial oxygen tension, oxygen/inspired oxygen fraction ratio and alveolo-arterial oxygen partial pressure difference were measured at preoperative period, 8 and 0hours before noninvasive positive-pressure ventilation and 8, 16, 24 and 48 hours after that. Results Elder age (older than 65 years) , current smoking ，low arterial oxygen tension /fraction of inspired oxygen, low endogenous creatinine clearance rate, 3 vessels involved and associated valvular disease may be the risk factors of failure to be extubated. The percentage of multiple grafts, large infusion and cardiopulmonary bypass in N group were much higher than that in C group. Plotting respiratory ratios with length of non-invasive positive pressure ventilation supports a significant improvement for all causes. Noninvasive positive-pressure ventilation prevent