雙向氣道正壓通氣應用於神經外科術後病人之成效-前導型試驗

Translated title of the contribution: The Efficacy of Biphasic Positive Airway Pressure Ventilation for Patients with Neurosurgery: A Preliminary Study

李俊年, 彭安瑜, 江盛君, 潘建南, 曹欣潔, 蘇千玲

Research output: Contribution to journalArticle

Abstract

Purpose: Postoperative neurosurgical patients had the high risks of developing pneumonia or lung injury due to the use of anesthetic agents. High tidal volume may further injury the lung. The purpose of this study is to examine the protective lung strategy via biphasic positive airway pressure (BIPAP) through the observation of (1) breathing pattern; (2) arterial blood gas; (3) hemodynamic; (4) intracranial pressure; (5) cerebral perfusion pressure in postoperative neurosurgical patients. Methods: This study was a prospective, randomized, controlled trial. Postoperative neurosurgical patients were randomized into control group ( setting value: volume assist/control mode, VT 10ml/kg/IBW, Ti l second ) and BIPAP group (setting value:BIPAP mode, Phigh: VT8ml/kg/IBW, Thigh 1 second and T low 4 seconds, and Phigh 80% to 100% setting value in pressure support), settings adjusted according to patient's clinical condition. All patients' respiratory rate were adjusted to maintain PaO2≧90mmHg or SaO2 or SpO2≧98%. Breathing pattern, hemodynamic and cerebral perfusion pressure were measured every 4 hours until patients were weaned from ventilator. Results: Total 26 patients were included in this study. 14 patients were in control group with 9 males (53.8%). 12 patients were in BIPAP group with 6 males (46.2%). There was no significant differences in age between control group (average 62.2 years) and BIPAP group (average 59.2 years). The tidal volume and minute volume were obviously lower in BIPAP group than in control group, (p<0.05). No obvious differences between the two groups in peak airway pressure, plateau pressure and positive end-expiratory pressure. Oxygen concentration and positive end expiratory pressure used was obviously lower in BIPAP group than in control group. Though PaO2 and PaCO2 were higher in BIPAP group, there was no significant difference between the two groups. Blood pressure (systolic pressure, diastolic pressure and mean blood pressure), intracranial pressure, and cerebral perfusion pressure also showed no difference between two groups (p>0.05). Days of ventilator use was shorter in BIPAP group than in control group (p=0.03). The number of pneumonia and tracheostomy developed were lower in the BIPAP group but no difference was observed between the two groups. The mortality rate in ICU was obviously lower in BIPAP group than in control group (p=0.04). Conclusion: When intracranial pressure were controlled and cerebral perfusion pressure were maintained at stable level, the application of low tidal volume protective lung strategy via biphasic positive airway pressure ventilation could effectively lower the setting of oxygen concentration, improve oxygenation and lower the days of using ventilator.
Original languageTraditional Chinese
Pages (from-to)21-30
Number of pages10
Journal呼吸治療
Volume9
Issue number1
DOIs
Publication statusPublished - 2010

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Positive-Pressure Respiration
Neurosurgery
Pressure
Cerebrovascular Circulation
Control Groups
Tidal Volume
Intracranial Pressure
Mechanical Ventilators
Blood Pressure
Lung Injury
Pneumonia
Respiration
Hemodynamics
Oxygen
Lung
Tracheostomy
Respiratory Rate
Thigh
Anesthetics
Randomized Controlled Trials

Keywords

  • protective lung strategy
  • biphasic positive airway pressure
  • brain injury
  • neurosurgery

Cite this

雙向氣道正壓通氣應用於神經外科術後病人之成效-前導型試驗. / 李俊年; 彭安瑜; 江盛君; 潘建南; 曹欣潔; 蘇千玲.

In: 呼吸治療, Vol. 9, No. 1, 2010, p. 21-30.

Research output: Contribution to journalArticle

李俊年 ; 彭安瑜 ; 江盛君 ; 潘建南 ; 曹欣潔 ; 蘇千玲. / 雙向氣道正壓通氣應用於神經外科術後病人之成效-前導型試驗. In: 呼吸治療. 2010 ; Vol. 9, No. 1. pp. 21-30.
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title = "雙向氣道正壓通氣應用於神經外科術後病人之成效-前導型試驗",
abstract = "目的:腦損傷病人手術後,發生肺炎或肺損傷之併發症危險度較高。已有很多研究探討麻醉過程及術中、術後呼吸通氣方式對肺部併發症之影響,但很少有關腦損傷病人之隨機控制研究。因此本研究想探討肺保護策略經雙向氣道正壓(Biphasic Positive Airway Pressure Vnentilation,BIPAP)對腦部術後病人之(1)呼吸型態(breathing pattern)及呼吸力學(respiration mechanic);(2) 動脈氣體分析(arterial blood gas)、血液動力學(hemodynamic)、顱內壓(intracranial pressure,ICP)與腦灌流壓(cerebral perfusion pressure, CPP);(3)加護單位臨床照護品質指標之影響。方法:本研究為前瞻性隨機控制前導型研究,腦損傷手術後病人隨機分為兩組,Control 組:volume assist/control mode,VT10ml/kg/IBW,Ti 1 秒為主要設定值;BIPAP 組:BIPAP mode, Phigh 以(VT8ml/kg/IBW)為設定值,Thigh 1 秒,Tlow 4 秒,Pressure Support 以 Phigh 80{\%}-100{\%}為設定值(根據病人臨床狀況調整)。所有病人的呼吸次數以維持 PaCO2 近 35mmHg,I/E ratio 1:2 ≧ 為設定值。氧氣初期設定 FiO2 40{\%},PEEP5cmH2O,維持 PaO2≧90 mmHg 或 SaO2或 SpO2≧98{\%},平均每四小時測量呼吸型態、血液動力學、腦壓與腦灌流壓,並追蹤病人至呼吸器脫離。結果:研究個案數共 26 人,Control 組 14 人中男性 9 位(64{\%}),BIPAP 組 12 人中男性 6 位(50{\%});控制組平均年齡 62.2 歲,BIPAP 組 59.2 歲,基本資料及腦部診斷兩組皆無顯著差異但控制組手術時間稍低(p=0.03)。BIPAP 組每公斤潮氣容積(tidal volume)、潮氣容積及每分鐘換氣量(minute volume)顯著低於Control 組 (p<0.05),其他呼吸力學參數兩組無顯著差異。氣體交換: BIPAP 組氧氣濃度及吐氣末正壓設定皆顯著低於 Control 組(p=0.03),同時 BIPAP 組 PaCO2顯著高於 Control 組(p=0.03),而 PaO2無顯著差異。血壓(收縮壓、舒張壓、平均壓)、顱內壓、腦灌流壓皆無組間差異。BIPAP 組呼吸器使用天數及加護病房死亡率顯著低於 Control 組(p=0.03;p=0.04),而肺炎及氣切人數皆無組間差異。結論:以雙向氣道正壓通氣用於腦部術後病人,雖 PaCO2稍高而 PaO2不變,故仍可維持穩定顱內壓及足夠腦灌流壓。而較低氧氣濃度及每公斤潮氣容積之設定,可符合肺保護策略,甚至可能降低呼吸器使用天數及加護病房死亡率。(呼吸治療 2010;9(1)21-30)",
keywords = "肺保護策略, 雙向氣道正壓, 腦損傷, 神經外科, protective lung strategy, biphasic positive airway pressure, brain injury, neurosurgery",
author = "李俊年 and 彭安瑜 and 江盛君 and 潘建南 and 曹欣潔 and 蘇千玲",
year = "2010",
doi = "10.6269/JRT.2010.9.1.03",
language = "繁體中文",
volume = "9",
pages = "21--30",
journal = "呼吸治療",
issn = "1991-2609",
publisher = "臺灣呼吸治療學會",
number = "1",

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TY - JOUR

T1 - 雙向氣道正壓通氣應用於神經外科術後病人之成效-前導型試驗

AU - 李俊年, null

AU - 彭安瑜, null

AU - 江盛君, null

AU - 潘建南, null

AU - 曹欣潔, null

AU - 蘇千玲, null

PY - 2010

Y1 - 2010

N2 - 目的:腦損傷病人手術後,發生肺炎或肺損傷之併發症危險度較高。已有很多研究探討麻醉過程及術中、術後呼吸通氣方式對肺部併發症之影響,但很少有關腦損傷病人之隨機控制研究。因此本研究想探討肺保護策略經雙向氣道正壓(Biphasic Positive Airway Pressure Vnentilation,BIPAP)對腦部術後病人之(1)呼吸型態(breathing pattern)及呼吸力學(respiration mechanic);(2) 動脈氣體分析(arterial blood gas)、血液動力學(hemodynamic)、顱內壓(intracranial pressure,ICP)與腦灌流壓(cerebral perfusion pressure, CPP);(3)加護單位臨床照護品質指標之影響。方法:本研究為前瞻性隨機控制前導型研究,腦損傷手術後病人隨機分為兩組,Control 組:volume assist/control mode,VT10ml/kg/IBW,Ti 1 秒為主要設定值;BIPAP 組:BIPAP mode, Phigh 以(VT8ml/kg/IBW)為設定值,Thigh 1 秒,Tlow 4 秒,Pressure Support 以 Phigh 80%-100%為設定值(根據病人臨床狀況調整)。所有病人的呼吸次數以維持 PaCO2 近 35mmHg,I/E ratio 1:2 ≧ 為設定值。氧氣初期設定 FiO2 40%,PEEP5cmH2O,維持 PaO2≧90 mmHg 或 SaO2或 SpO2≧98%,平均每四小時測量呼吸型態、血液動力學、腦壓與腦灌流壓,並追蹤病人至呼吸器脫離。結果:研究個案數共 26 人,Control 組 14 人中男性 9 位(64%),BIPAP 組 12 人中男性 6 位(50%);控制組平均年齡 62.2 歲,BIPAP 組 59.2 歲,基本資料及腦部診斷兩組皆無顯著差異但控制組手術時間稍低(p=0.03)。BIPAP 組每公斤潮氣容積(tidal volume)、潮氣容積及每分鐘換氣量(minute volume)顯著低於Control 組 (p<0.05),其他呼吸力學參數兩組無顯著差異。氣體交換: BIPAP 組氧氣濃度及吐氣末正壓設定皆顯著低於 Control 組(p=0.03),同時 BIPAP 組 PaCO2顯著高於 Control 組(p=0.03),而 PaO2無顯著差異。血壓(收縮壓、舒張壓、平均壓)、顱內壓、腦灌流壓皆無組間差異。BIPAP 組呼吸器使用天數及加護病房死亡率顯著低於 Control 組(p=0.03;p=0.04),而肺炎及氣切人數皆無組間差異。結論:以雙向氣道正壓通氣用於腦部術後病人,雖 PaCO2稍高而 PaO2不變,故仍可維持穩定顱內壓及足夠腦灌流壓。而較低氧氣濃度及每公斤潮氣容積之設定,可符合肺保護策略,甚至可能降低呼吸器使用天數及加護病房死亡率。(呼吸治療 2010;9(1)21-30)

AB - 目的:腦損傷病人手術後,發生肺炎或肺損傷之併發症危險度較高。已有很多研究探討麻醉過程及術中、術後呼吸通氣方式對肺部併發症之影響,但很少有關腦損傷病人之隨機控制研究。因此本研究想探討肺保護策略經雙向氣道正壓(Biphasic Positive Airway Pressure Vnentilation,BIPAP)對腦部術後病人之(1)呼吸型態(breathing pattern)及呼吸力學(respiration mechanic);(2) 動脈氣體分析(arterial blood gas)、血液動力學(hemodynamic)、顱內壓(intracranial pressure,ICP)與腦灌流壓(cerebral perfusion pressure, CPP);(3)加護單位臨床照護品質指標之影響。方法:本研究為前瞻性隨機控制前導型研究,腦損傷手術後病人隨機分為兩組,Control 組:volume assist/control mode,VT10ml/kg/IBW,Ti 1 秒為主要設定值;BIPAP 組:BIPAP mode, Phigh 以(VT8ml/kg/IBW)為設定值,Thigh 1 秒,Tlow 4 秒,Pressure Support 以 Phigh 80%-100%為設定值(根據病人臨床狀況調整)。所有病人的呼吸次數以維持 PaCO2 近 35mmHg,I/E ratio 1:2 ≧ 為設定值。氧氣初期設定 FiO2 40%,PEEP5cmH2O,維持 PaO2≧90 mmHg 或 SaO2或 SpO2≧98%,平均每四小時測量呼吸型態、血液動力學、腦壓與腦灌流壓,並追蹤病人至呼吸器脫離。結果:研究個案數共 26 人,Control 組 14 人中男性 9 位(64%),BIPAP 組 12 人中男性 6 位(50%);控制組平均年齡 62.2 歲,BIPAP 組 59.2 歲,基本資料及腦部診斷兩組皆無顯著差異但控制組手術時間稍低(p=0.03)。BIPAP 組每公斤潮氣容積(tidal volume)、潮氣容積及每分鐘換氣量(minute volume)顯著低於Control 組 (p<0.05),其他呼吸力學參數兩組無顯著差異。氣體交換: BIPAP 組氧氣濃度及吐氣末正壓設定皆顯著低於 Control 組(p=0.03),同時 BIPAP 組 PaCO2顯著高於 Control 組(p=0.03),而 PaO2無顯著差異。血壓(收縮壓、舒張壓、平均壓)、顱內壓、腦灌流壓皆無組間差異。BIPAP 組呼吸器使用天數及加護病房死亡率顯著低於 Control 組(p=0.03;p=0.04),而肺炎及氣切人數皆無組間差異。結論:以雙向氣道正壓通氣用於腦部術後病人,雖 PaCO2稍高而 PaO2不變,故仍可維持穩定顱內壓及足夠腦灌流壓。而較低氧氣濃度及每公斤潮氣容積之設定,可符合肺保護策略,甚至可能降低呼吸器使用天數及加護病房死亡率。(呼吸治療 2010;9(1)21-30)

KW - 肺保護策略

KW - 雙向氣道正壓

KW - 腦損傷

KW - 神經外科

KW - protective lung strategy

KW - biphasic positive airway pressure

KW - brain injury

KW - neurosurgery

U2 - 10.6269/JRT.2010.9.1.03

DO - 10.6269/JRT.2010.9.1.03

M3 - 文章

VL - 9

SP - 21

EP - 30

JO - 呼吸治療

JF - 呼吸治療

SN - 1991-2609

IS - 1

ER -