Effects of prophylactic use of noninvasive positive pressure ventilation following stanford type A aortic dissection operation
10.3760/cma.j.issn.1001-4497.2017.01.004
- VernacularTitle:Stanford A型主动脉夹层术后预防性应用无创正压通气的效果研究
- Author:
Yi YANG
;
Nan LIU
;
Lizhong SUN
;
Yong YANG
- Keywords:
Noninvasive ventilation;
Positive-pressure ventilation;
Hypoxemia;
Stanford type A aortic dissection
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2017;33(2):81-86
- CountryChina
- Language:Chinese
-
Abstract:
Objective To assess the efficacy of the prophylactic de-escalation use of noninvasive positive pressure ventilation(NPPV) in improvement of oxygenation following extubation after stanford type A aortic dissection.Methods 40 patients recovering from the stanford type A aortic dissection operation in the Center for Cardiac Intensive Care,Beijing Anzhen Hospital between December 2015 and April 2016,and meet the inclusion criterion after extubation,were investigated.The patients were random divided into 2 groups with RandA1.0 software,each group contained 20 patients:NPPV with mask vs.traditional oxygen treatment with mask.NPPV initial 2 h(started from extubation) settings:inspiratory pressure(IPAP) of 14-16 cmH2 O,expiratory pressure (EPAP) of 6-8 cmH2 O,the fraction of inspired oxygen (FiO2) of 0.35-0.55.2-8 h the parameters of setting were decreased:IPAP l0-12 cmH2 O,EPAP 4 cmH2 O.After 8 h the NPPV was finished and the oxygen treatment instead.The oxygen treatment settings:the flux inhalation of oxygen was 6-10 L/min,and FiO2 was adjusted to 0.35-0.55.Make a comparison with the two groups in the clinical effect at 2 h,8 h,24 h,3 days,and to compare their reintubation rate.Results PaO2 and PaO2/FiO2 were higher in the prophylactic NPPV group compared to oxygen treatment group after 2 h [94.7(89.7,100.1) mmHg vs.84.5(78.7,87.1) mmHg,P ＜0.05.(192.7 ±31.2) mmHg vs.(167.0 ± 18.9) mmHg,P＜0.05],8 h[99.1(90.3,132.8) mmHgvs.86.3(82.3,95.6) mmHg,P＜0.05.198.2(180.5,246.2) mmHg vs.172.5(164.7,191.2) mmHg,P ＜0.05],24 h[(100.0 ± 18.9) mmHg vs.(87.3 ±12.9) mmHg,P＜ 0.05.(197.5±36.8) mmHgvs.(170.1 ±29.8) mmHg,P＜0.05] and3 days[98.2(87.4,110.5)mmHg vs.86.8 (79.4,89.6) mmHg,P ＜ 0.05.(193.2 ± 37.1) mmHg vs.(164.4 ± 23.8) mmHg,P ＜ 0.05],and respiratory rate was lower in the NPPV group at the same time.Heart rate and mean arterial pressure were lower in the NPPV group at 24 h and 3 days.At 3 days in the NPPV group PaCO2 was lower,and left ventricular ejection fraction was improved.But the treatment of traditional oxygen leaded to a higher incidence of pulmonary atelectasis,and more longer hospitalization time.Conclusion In the early stage after extubation,prophylactic de-escalation therapy of NPPV for patients following operation of stanford type A aortic dissection,may quickly improve PaO2/FiO2,and increase the function of heart,avoid atelectasis.Furthermore,hospital stay was eventually shortened in NPPV group.
