无创正压通气在肺功能中重度减低行电视胸腔镜肺切除术后患者中的应用

摘要

Objective To observe the effect of noninvasive positive pressure ventilation ( NPPV) on pulmonary func-tion in severe video-assisted thoracoscopic lung resection patients .Methods 60 patients who underwent minimally invasive video-assisted thoracoscopic operation in department of thoracic surgery were included ;they were randomly divided into control group (28 cases) and NPPV group (32 cases).The 2 groups were given conventional anti infection , inhalation, analgesic, nutritional support treatment .Based on conventional therapy , the NPPV group received NPPV treatment .The control group re-ceived venturi mask or nasal catheter oxygen treatment with oxygen concentration 30%~50%.Before and after operation , chest tube removal time , gas drainage , hospitalization time and incidence of pulmonary complications were recorded and ana -lyzed in the 2 groups.Results Compared with control group , after surgery, NPPV group's partial pressure of oxygen [(74.20 ±9.41) mm Hg vs.(60.30 ±8.22) mm Hg],carbon dioxide [(40.38 ±7.66) mm Hg vs.(48.34 ±8.46) mm Hg],pH value (7.385 ±0.059 vs.7.315 ±0.039), extubation time [(3.2 ±1.4) d vs.(5.3 ±1.2) d], the total drainage vol-ume [(638.6 ±32.2) ml vs.(850.8 ±68.4) ml], admission time (10.3 ±2.4) d vs.(15.8 ±2.6) d)was improved sig-nificantly ( P <0.05), lung complications rate was 21.9% in NPPV group (7/32), lower than that of the control group 57.2%(16/28) ( P <0.05).Conclusion Prophylactic NPPV treatment for patients with pulmonary function severely re-duced before video-assisted thoracoscopic lung resection operation can improve the curative effect , reduce the incidence of pul-monary complications .%目的：观察无创正压通气（ NPPV）在肺功能中重度减低行电视胸腔镜肺切除手术患者中的临床疗效。方法符合入选条件的胸外科电视胸腔镜微创手术后患者60例，随机分为对照组（28例）和NPPV组（32例）。2组术后均给予常规抗感染、雾化吸入、止痛、营养支持等治疗。 NPPV组在常规治疗基础上，给予NPPV治疗。对照组采用文丘里面罩或鼻导管吸氧，氧浓度30％～50％。记录2组患者手术前后血气分析、胸腔管拔除时间、胸腔引流量、住院时间及肺部并发症发生率。结果与对照组比较，NPPV组术后氧分压[（74妸．20±9．41）mm Hg vs．（60．30±8．22）mm Hg]、二氧化碳分压[（40．38±7．66）mm Hg vs．（48．34±8．46）mm Hg]、pH值（7．385±0．059 vs．7．315±0．039）、拔管时间[（3．2±1．4）d vs．（5．3±1．2）d]、总引流液量[（638．6±32．2）ml vs．（850．8±68．4）ml]、住院时间[（10．3±2．4）d vs．（15．8±2．6）d]等均明显改善（ P ＜0．05），肺部并发症发生率NPPV组为21．9％（7/32），低于对照组的57．2％（16/28）（ P ＜0．05）。结论对于肺功能中重度减低行电视胸腔镜肺切除手术患者预防性应用NPPV治疗，可以提高疗效，减少肺部并发症的发生。