Department of Surgery Intensive Care Unit, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200030, China;
Department of Physiology, School of Basic Science, Guangzhou Medical University, Guangzhou 510282, China;
J Thorac Dis. 2013 Dec;5(6):777-82. doi: 10.3978/j.issn.2072-1439.2013.09.09.
To evaluate the therapeutic efficacy of noninvasive positive pressure ventilation (NPPV) in the treatment of acute respiratory distress syndrome (ARDS) following esophagectomy for esophageal cancer.
In this retrospective evaluation, we included 64 patients with ARDS following esophagectomy for esophageal cancer between January 2009 and December 2011. The primary evaluations were 28-day fatality and actual fatality. The secondary evaluations were sex, age, onset time, pH value, PaO2/FiO2, sequential organ failure assessment (SOFA) score, acute physiology and chronic health evaluation (APACHE-II) score, and presence or absence after surgery of major surgery-related complications such as cardiac arrest, anastomotic fistula, and acute renal dysfunction.
NPPV applied as the first-line intervention for ARDS following esophagectomy for esophageal cancer avoided intubation in 30 patients (30/64, 48.4%). There were no significant differences in gender, age, PaO2/FiO2, SOFA score, or APACHE-II score between the NPPV group and the patients who required invasive positive pressure ventilation (IPPV group) (P>0.05) at the time of onset, while differences in the PaO2/FiO2 (P<0.05) after 24 h of NPPV and presence of major surgery-related complications were highly significant (P<0.01).
NPPV may be an effective option for the treatment of ARDS/acute lung injury (ALI) following esophagectomy for esophageal cancer. However, conversion to invasive mechanical ventilation should be considered in patients with severe postoperative complications such as acute renal dysfunction and cardiac arrest and in those with PaO2/FiO2 <180 after 2 h of NPPV.
评估无创正压通气（NPPV）在治疗食管癌手术后急性呼吸窘迫综合征（ARDS）中的疗效。
在这项回顾性评估中，我们纳入了 2009 年 1 月至 2011 年 12 月期间因食管癌手术后发生 ARDS 的 64 例患者。主要评估指标为 28 天病死率和实际病死率。次要评估指标为性别、年龄、发病时间、pH 值、PaO2/FiO2、序贯器官衰竭评估（SOFA）评分、急性生理与慢性健康评分（APACHE-II）评分，以及手术后是否存在心脏骤停、吻合口瘘和急性肾功能障碍等主要手术相关并发症。
NPPV 作为食管癌手术后 ARDS 的一线干预措施，避免了 30 例患者（30/64，48.4%）进行气管插管。在发病时，NPPV 组与需要有创正压通气（IPPV 组）的患者在性别、年龄、PaO2/FiO2、SOFA 评分或 APACHE-II 评分方面无显著差异（P>0.05），但在 NPPV 治疗 24 小时后 PaO2/FiO2（P<0.05）和存在主要手术相关并发症方面差异有统计学意义（P<0.01）。
NPPV 可能是治疗食管癌手术后 ARDS/急性肺损伤（ALI）的有效方法。然而，对于术后并发急性肾功能障碍和心脏骤停等严重并发症的患者，以及在 NPPV 治疗 2 小时后 PaO2/FiO2<180 的患者，应考虑转换为有创机械通气。
