冠状动脉旁路移植术后撤机困难的序贯通气治疗程智广，杨传瑞，李大连，郭建中，高翔，杨峰(首都医科大学附属北京友谊医院心脏中心心脏外科，北京100050)摘要：目的探讨冠状动脉旁路移植术后撤机困难应用有创-无创序贯通气治疗的有效性。方法2005年12月-2010年2月我院行冠状动脉旁路移植术手术360例，21例出现撤机困难而行无创通气治疗，设为研究纽.(N组，n=21),余为对照组(C组,n=339)o分别在术前、治疗前8h、治疗即刻、治疗后8h、16h、24h、48h七个时间点观察呼吸次数、动脉血气指标、心率、肺动脉楔压、氧合指数及肺泡-动脉氧分压差等指标的变化。结果N组高龄(>65岁)、近期吸烟、氧合指数低、肌酹清除率低、三支血管病变及合并瓣膜病变比例高于C组，差异有统计学意义(P<0.05)oN组术中搭桥数量M3支较多、输血量较大，转机比例较高，差异有统计学意义(卩<0.05)。无创通气治疗后呼吸次数、动脉血气指标、心率、肺动脉楔压、氧合指数及肺泡-动脉氧分压差显著改善(P<0.05),无创通气对于心源性肺水肿、肺不张和急性肺损治疗效果显著。肺部感染患者2例，行再次插管1例。总有效率95.3%。结论冠状动脉旁路移植术后撤机困难患者应用有创-无创序贯通气治疗，能够改善氧合，尽早拔管。关键词：无创通气；呼吸功能衰竭；冠状动脉旁路移植术中图分类号：R654.2文献标识码：AInvasive-noninvasivesequentialventilationforextubationfailureaftercoronaryarterybypasssurgeryCHENGZhi-guang,YANGChuan-rui,LIDa-lian,GUOJian-zhong,GAOXiang,YANGFeng(DepartmentofCardiacSurgery,BeijingFriendshipHospitalAffiliatedtoCapitalMedicalUniversity,Beijing100050,China)Abstract:ObjectiveThisstudyaimstoassesswhethertheapplicationofnon・invasivepositivepressureventilationcancorrectimpedimentsofweaningfrommechanicalventilationinthosepatientswhofailedtobeextubatedaftercoronaryarterybypasssurgery.Methods360patientsundergoingcoronaryarterybypasssurgerywereineludedinthestudyduringDecember2005toFebruary2010.Thosepatientsweredividedintonorvinvasivepositivepressureventilationgroup(Ngroup,n=21)andcontrolgroup(Cgroup,n=329).Duringnon-invasivepositivepressureventilation〃meanarterialpressure,heartraterespiratoryrate,arterialpH,arterialoxygensaturation,pulmonaryarterialwedgepressure,arterialcarbondioxidesaturation,arterialoxygentension,oxygen/inspiredoxygenfractionratioandalveolo-arterialoxygenpartialpressuredifferenceweremeasuredatpreoperativeperiod,8andOhoursbeforenoninvasivepositive-pressureventilationand8,16,24and48hoursafterthat.ResultsElderage(olderthan65years),currentsmoking,lowarterialoxygentension/fractionofinspiredoxygen,lowendogenouscreatinineclearaneerate,3vesselsinvolvedandassociatedvalvulardiseasemaybetheriskfactorsoffailuretobeextubated・Thepercentageofmultiplegrafts,largeinfusionandcardiopulmonarybypassinNgroupweremuchhigherthanthatinCgroup・Plottingrespiratoryratioswithlengthofnon-invasivepositivepressureventilationsupportsasignificantimprovementforallcauses・Noninvasivepositive-pressureventilationpreventedintubationin95.3%ofthepatients,withsatisfactoryrecoveryforpostcardiopulmonarybypasslunginjury,cardiogenicdysfunction证据呢andatelectasisandpoorresults(1of2casesreintubated)inthosetreatedforpneumonia・ConclusionInappropriatecandidates,noninvasivepositive-pressureventilationexertsfavorableeffectsonlungfunction”earlyextubationandpreventin呂reintubation.KeywordsNoninvasivepositive-pressureventilation,Lungfunctionfailure,Coronaryarterybypassgraftsurgery［通信作者］程智广,电话:(010)63138701：E-mail：drcheng@139.com大多数患者行冠状动脉旁路移植(coronaryarterybypassgrafting,CABG)术后6-8h拔除气管插管，然而撤机困难...