Đánh giá hiệu quả thông khí áp lực dương không xâm nhập có hỗ trợ áp lực (BiPAP) trên bệnh nhân suy hô hấp do suy tim cấp mất bù

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Tác giả: Anh Sơn Đặng, Việt Đức Đặng, Quang Minh Lưu, Hoài Thu Ngô, Thành Huy Nguyễn, Sơn Lâm Phạm, Văn Chính Phạm, Đình Hùng Vũ

Ngôn ngữ: vie

Ký hiệu phân loại: 611.2 Respiratory organs

Thông tin xuất bản: Tạp chí Y dược lâm sàng 108, 2022

Mô tả vật lý: 16-23

Bộ sưu tập: Metadata

ID: 498980

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Chủ đề

Đánh giá hiệu quả của thông khí áp lực dương không xâm nhập có hỗ trợ áp lực (BiPAP) trên bệnh nhân suy hô hấp cấp do suy tim cấp mất bù. Đối tượng và phương pháp: Nghiên cứu mô tả 39 bệnh nhân suy hô hấp cấp do suy tim cấp mất bù không đáp ứng với điều trị nội khoa tiêu chuẩn được hỗ trợ hô hấp bằng thông khí áp lực dương không xâm nhập tại Khoa Hồi sức tim mạch, Bệnh viện Trung ương Quân đội 108 từ tháng 6/2020 đến tháng 11/2020. Kết quả: Trong 39 bệnh nhân được thông khí áp lực dương không xâm nhập, có 3 bệnh nhân phải chuyển đặt ống nội khí quản thở máy xâm nhập (7,7%), thời gian thở máy không xâm trung bình là 153,46 ± 47,16 phút, thời gian nằm viện trung bình 10,51 ± 6,03 ngày. Các thông số lâm sàng và khí máu cải thiện có ý nghĩa thống kê ngay trong giờ đầu. Biến chứng do thông khí áp lực dương không xâm nhập: Tổn thương da mặt, khô mắt (23,1%), trào ngược dạ dày - thực quản (12,8%), viêm phổi (7,7%), tụt huyết áp (7,7%). Thời gian thở máy không xâm nhập có mối tương quan thuận mức độ vừa với pH ban đầu (r = 0,392, p<
0,05) và tương quan nghịch mức độ vừa pCO2 ban đầu (r = -0,459, p<
0,01). Kết luận: Thông khí áp lực dương không xâm nhập là một phương pháp điều trị an toàn và hiệu quả, nên được áp dụng rộng rãi cho bệnh nhân suy tim cấp mất bù. Thời gian thở máy có liên quan với pH và pCO2 máu động mạch.To assess the efficacy of non-invasive pressure support ventilation (NPPV) in patients with acute respiratory failure due to acute decompensated heart failure (ADHF). Subject and method: A descriptive study on 39 ADHF patients suffering from ARF which is refractory to standard medical care at the Cardiovascular Intensive Care Unit, 108 Military Central Hospital from June to November in the year 2020. Result: In these patients, the rate of intubation was 7.7% (3 of 39 patients), the mean duration of non-invasive ventilation was 153.46 ± 47.16 minutes and the length of hospital stay was 10.51 ± 6.03 days. Clinical parameters and arterial blood gas improve statistically in first hour. In-hospital death occurred in 3 patients, account for 7.7%, the adverse complications included skin injury (23.1%), aspiration (12.8%), pneumonia (7.7%) and hypotension (7.7%). There was a moderate negative correlation between pH and NPPV duration (r = -0.392, p<
0.05) and moderately positive correlation (r = 0.459, p<
0.01) between arterial level of CO2 and NPPV duration (r = 0.459, p<
0.01). Conclusion: NPPV is a safe and effective therapy which should be widely used for ADHF patients. The duration of NPPV correlates to arterial level of pH and CO2.

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