持续的正气道压力用于治疗术后低氧症:一项随机对照试验
Vincenzo Squadrone1, Massimiliano Coha, Elisabetta Cerutti
1Dipartimento di Anestesia, Azienda Ospedaliera S.Giovanni Battista-Molinette, Università di Torino, Italy.
JAMA
|February 3, 2005
概括
持续的正气道压力 (CPAP) 显著减少了腹部手术后缺氧症患者的输入管的需要. 此外,CPAP还降低了肺炎,感染和败血症的发生率,改善了患者的治疗结果.
科学领域:
- 临界护理医学 临界护理医学
- 呼吸系统医学 呼吸系统医学
- 术后恢复 术后恢复
背景情况:
- 腹部手术后的低氧症影响30-50%的患者.
- 在8-10%的患者中,需要输管和机械通风,从而增加了发病率和死亡率.
- 长时间的ICU和住院是常见的并发症.
研究的目的:
- 为了评估持续的正气道压力 (CPAP) 与在腹部外科手术后的低氧症中预防输内管道的标准治疗.
- 评估CPAP在减少严重呼吸道并发症方面的有效性.
主要方法:
- 一个随机的,受控的,未盲目的试验,涉及209名患有严重低氧化症的大型选择性腹部手术后的患者.
- 患者接受了单独的氧气或氧气加CPAP.
- 主要终点:内内输管发生率. 二级终点:重症监护室/住院,肺炎,感染,败血症和死亡率.
主要成果:
- 在CPAP组,输管率显著降低 (1%对10%,P=.005).
- 在CPAP组中,肺炎 (2% vs 10%),感染 (3% vs 10%) 和败血症 (2% vs 9%) 的发病率较低.
- CPAP组的ICU停留时间较短 (P = .09) 并且没有住院死亡,而标准治疗组的死亡人数为3人 (P = .12).
结论:
- 持续的正气道压力 (CPAP) 有效地降低腹腔外科手术后低血症患者的内管道输入.
- CPAP可以减少肺炎,感染和败血症等严重并发症.
- 在这种患者群体中,CPAP显示出改善治疗结果和降低死亡率的潜力.
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