在患有慢性呼吸系统疾病的超患者中,输出管后的非侵入性通风:随机对照试验
Miquel Ferrer1, Jacobo Sellarés, Mauricio Valencia
1Servei de Pneumologia, Institut Clínic del Tòrax, Hospital Clinic, IDIBAPS, Universitat de Barcelona, Barcelona, Spain. miferrer@clinic.ub.es
Lancet (London, England)
|August 18, 2009
概括
早期的非侵入性通风显著降低了呼吸衰竭和90天的死亡率,在外抽术后的超患者. 这种有效的策略推用于慢性呼吸系统疾病的通风患者.
科学领域:
- 关键护理医学 关键护理医学
- 呼吸系统医学 呼吸系统医学
- 肺部生理学 肺部生理学
背景情况:
- 非侵入性通风 (NIV) 已被认为可以预防高风险个体的输出管后呼吸衰竭.
- 之前的研究表明,使用NIV的超患者的生存率有所改善.
- 这项研究前性地评估了NIV在脱口术后和作为救援疗法的超患者的有效性.
研究的目的:
- 评估非侵入性通风 (NIV) 在排气后72小时内预防呼吸衰竭的有效性.
- 评价NIV作为救援疗法的作用,用于输出管后呼吸衰竭.
- 为了确定NIV对90天死亡率的影响,在hypercapnic患者.
主要方法:
- 在西班牙三个重症监护病房进行了一项随机对照试验.
- 在自发呼吸试验后,有106名患有慢性呼吸系统疾病和头过高的机械呼吸患者被纳入试验.
- 参与者被随机分配,接受24小时NIV (n=54) 或常规氧气疗法 (n=52) 输出管后.
主要成果:
- 与常规氧气组 (25/48) 相比,NIV组 (8/54) 的呼吸衰竭发生的频率较低 (p<0.0001).
- 作为救援疗法的NIV成功避免了27名患者中的17名患者的再输管.
- 独立地,NIV与输出管后呼吸衰竭的风险显著降低 (调整后几率比0.17) 和90天死亡率降低 (p=0.0146) 相关.
结论:
- 在输出管后早期应用非侵入性通风可大大降低呼吸衰竭的风险.
- 此外,NIV的实施还能显著降低超患者90天死亡率.
- 建议常规使用NIV来管理患有慢性呼吸系统疾病的机械通风患者.
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