【摘要】 评价鼻面罩双水平气道正压 (BiPAP)支持对心血管外科术后呼吸衰竭的疗效。方法　将 33例术后呼吸支持≥ 72小时的病人在拔除气管内插管 (以下简称插管 )后分为BiPAP支持组 (A组 ,17例 )和普通面罩吸氧组 (B组 ,16例 )。主要研究RR(呼吸频率 )、PaCO2 (动脉血二氧化碳分压 )、A -aDO2 (肺泡 -动脉氧分压差 )、呼吸指数 (RI)及肺内分流量(Qs/Qt)变化。结果　A、B组年龄和术后插管时间分别是 5 2± 8岁、45± 7岁和 10± 7天、5± 3天。B组 3例再次插管 ,2 4小时内RR加快 (P <0 1)。A组 7例 48小时内是间断使用BiPAP支持 ,无再次插管 ,RI显著改善 (1 6± 0 3→ 0 8± 0 2 ,P <0 0 1) ,A -aDO2 和Qs/Qt减小 (P <0 1)。结论　BiPAP支持对术后呼吸衰竭是有效的非介入性治疗方法 ,避免长时间的插管更多还原

【Abstract】 Objective To assess the efficacy of nasal mask BiPAP positive airway pressure(BiPAP)support in managing respiratory failure following cardiovascular surgery.Methods A total of 29 patients requiring postoperation prolonged respiratory support of 72 hours or longer were assigned into BiPAP group(group A,17 patients)and ordinary oxygen mask treatment group(group B,16 patients)after extubation.Respiratory Rate(RR),Arterial partial pressure of carbon dioxide(PaCO 2),respiratory Alveolar-arterial oxygen difference(A-aDO 2),Respiratory indox(RI)and Veno-arterial shunt ratio(Qs/Qt)were mainly studied.Results the mean age of the group A and group B was 52±8 and 45±7 years of age,respectively.the mean period of postoperative endotracheal intubation of the group A and group B was 10±7 days and 5±3 days,respectively.Reintubation was mecessary in 3 patients of the group B.The RR of the B group increased( P <0 1)24 hours after extubation.The group A patients required no reintubation.BiPAP support was discontinued within 48 hours in 7 out of 17 patients.The values of the RI of the group A improved significantly after BiPAP management from 1 6±0 3 to 0 8±0 2( P <0 01).A-aDO 2 and Qs/Qt decreased( P <0 1)in the group A.Conclusion BiPAP support is an effective managment technique for postoperative respiratory failure and may also prevent prolonged endotracheal intubation. [更多还原