论文部分内容阅读
目的探讨无创正压通气(NPPV)在肾移植术后呼吸衰竭患者中的临床价值。方法回顾性分析2010年7月至2013年5月复旦大学附属中山医院麻醉与外科监护室(SICU)收治的17例肾移植术后使用NPPV治疗呼吸衰竭患者的临床资料,观察患者NPPV治疗前、治疗1 h后及治疗结束时动脉血压分压/氧体积分数(PaO2/FiO2)的变化,同时记录NPPV时间和预后情况。根据NPPV治疗后患者病情的改善情况,将患者分为NPPV成功组和NPPV失败组。正态分布计量资料使用成组t检验进行比较,非正态分布计量资料使用Mann-Whitney U检验进行比较。使用Fisher精确概率法比较NPPV成功组和失败组患者死亡比例。使用单因素方差分析比较NPPV治疗前、治疗1 h后及治疗结束时成功组和失败组患者PaO2/FiO2的变化情况,并用LSD方法进行两两比较。结果 17例患者中男性13例,女性4例,平均年龄(49±13)岁(19~68岁)。分别于肾移植术后11 d~8 y发生急性呼吸衰竭,行NPPV治疗,共8例成功,9例失败。两组患者在进入SICU时疾病严重程度具有可比性,PaO2/FiO2基线情况差异无统计学意义(t=-1.036,P>0.05)。成功组患者NPPV治疗1 h后、治疗结束时PaO2/FiO2分别为193±62和238±31,均高于治疗前146±31,差异均有统计学意义(P均<0.05);而NPPV治疗结束与治疗1 h后相比,差异无统计学意义(P>0.05),提示PaO2/FiO2未再持续改善。失败组患者NPPV治疗前、治疗1 h后及治疗结束相比较,PaO2/FiO2差异均无统计学意义(F=1.585,P>0.05)。8例NPPV成功组患者死亡1例,9例失败组患者死亡7例,两组患者死亡比例差异有统计学意义(P=0.015)。成功组中生存和死亡患者NPPV中位时间分别为240 h和93 h,差异无统计学意义(z=-1.098,P>0.05)。失败组中存活和死亡患者NPPV时间分别为24 h和65 h,差异有统计学意义(z=-2.049,P<0.05)。结论 NPPV可用于治疗肾移植术后呼吸衰竭患者。NPPV治疗1 h后PaO2/FiO2改善明显可预测NPPV成功,但若改善不明显应及时终止NPPV,转为有创机械通气治疗。
Objective To investigate the clinical value of noninvasive positive pressure ventilation (NPPV) in patients with respiratory failure after renal transplantation. Methods The clinical data of 17 NPPV-treated patients with respiratory failure after renal transplantation admitted from July 2010 to May 2013 in Zhongshan Hospital of Fudan University were retrospectively analyzed. Before and after NPPV treatment, The changes of PaO2 / FiO2 at 1 h after treatment and at the end of treatment were recorded. The time and prognosis of NPPV were recorded. According to the improvement of the patient’s condition after NPPV treatment, the patients were divided into NPPV successful group and NPPV failed group. Normal distribution measurements were compared using a group t-test, and non-normal distribution measurements were compared using the Mann-Whitney U test. The Fisher exact test was used to compare the proportion of deaths between NPPV-treated and failed patients. One-way analysis of variance (ANOVA) was used to compare changes of PaO2 / FiO2 in NPPV patients before treatment, at 1 h after treatment and at the end of treatment, and LSD method was used to compare the two groups. Results Of the 17 patients, 13 were males and 4 were females, with an average age of 49 ± 13 years (19-68 years). Acute respiratory failure occurred on the 11th and 8th day after renal transplantation, and NPPV was performed. A total of 8 cases were successful and 9 cases failed. There was no significant difference in PaO2 / FiO2 baseline between the two groups when entering SICU (t = -1.036, P> 0.05). PaO2 / FiO2 at the end of treatment was 193 ± 62 and 238 ± 31 at 1 h after NPPV treatment in the successful group, both of which were significantly higher than those of 146 ± 31 before treatment (all P <0.05). NPPV treatment There was no significant difference between the end and 1 h after treatment (P> 0.05), suggesting no further improvement of PaO2 / FiO2. There was no significant difference in PaO2 / FiO2 between the failure group before NPPV treatment and 1 h after treatment and after treatment (F = 1.585, P> 0.05). One patient died in 8 NPPV successful patients, 7 patients died in 9 failed patients, and the difference was statistically significant (P = 0.015). The median survival time and death NPPV in the successful group were 240 h and 93 h, respectively, with no significant difference (z = -1.098, P> 0.05). The NPPV time of surviving and death patients in failed group were 24 h and 65 h, respectively, with significant difference (z = -2.049, P <0.05). Conclusion NPPV can be used to treat patients with respiratory failure after renal transplantation. After 1 h of NPPV treatment, the improvement of PaO2 / FiO2 can obviously predict the success of NPPV. However, NPPV should be promptly terminated if the improvement is not obvious, then switched to invasive mechanical ventilation.