Aguiló R, Togores B, Pons S, Rubí M, Barbé F, Agustí A G
Serveis de Cirurgia Torácica, Hospital Universitari, Son Dureta, Palmade Mallorca, Spain.
Chest. 1997 Jul;112(1):117-21. doi: 10.1378/chest.112.1.117.
To investigate the short-term effects of noninvasive ventilatory support (NIVS) on pulmonary gas exchange, ventilatory pattern, systemic hemodynamics, and pleural air leaks in patients submitted to elective lung resection.
Prospective, randomized, parallel, and controlled investigation.
Thoracic Surgery Unit, Hospital Universitari Son Dureta, Palma Mallorca, Spain.
Nineteen patients electively submitted to lung resection because of varied clinical reasons.
Medical therapy was standardized for all patients. Ten subjects received NIVS with a nasal ventilatory support system (BiPAP) during 1 h (study group). The remaining nine individuals constituted the control group.
Arterial blood gases, ventilatory pattern, systemic hemodynamics, and pleural air leaks were measured. Before surgery, there were no significant clinical or functional differences between groups. After surgery, and compared with preoperative measures, PaO2 decreased significantly (p<0.01) and to the same extent both in the study group (85.7+/-2.8 to 68.0+/-2.7 mm Hg) and the control group (83.6+/-2.5 to 67.3+/-2.6 mm Hg). In the study group, NIVS increased PaO2 (to 76.7+/-3.0 mm Hg; p<0.05) and decreased alveolar to arterial oxygen pressure gradient (P[A-a]O2) (27.2+/-2.7 to 17.6+/-2.3 mm Hg; p<0.05). This latter effect was still present 1 h after withdrawing NIVS. By contrast, PaO2 and P(A-a)O2 remained unchanged in the control group throughout the study. PaCO2, the ventilatory pattern, and systemic hemodynamics did not change significantly throughout the study in any group. Importantly, NIVS did not increase dead space to tidal volume ratio or worsen pleural air leaks.
Short-term NIVS with a ventilatory support system improves the efficiency of the lung as a gas exchanger without noticeable nondesired side effects in patients submitted to lung resectional surgery.
探讨无创通气支持（NIVS）对择期肺切除患者肺气体交换、通气模式、全身血流动力学及胸膜漏气的短期影响。
前瞻性、随机、平行对照研究。
西班牙马略卡帕尔马市Son Dureta大学医院胸外科。
19例因各种临床原因择期行肺切除的患者。
所有患者的药物治疗均标准化。10名受试者在1小时内接受鼻通气支持系统（BiPAP）的无创通气支持（研究组）。其余9名个体组成对照组。
测量动脉血气、通气模式、全身血流动力学及胸膜漏气情况。术前，两组间无显著临床或功能差异。术后，与术前测量值相比，两组的动脉血氧分压（PaO2）均显著下降（p<0.01），且下降程度相同，研究组从85.7±2.8 mmHg降至68.0±2.7 mmHg，对照组从83.6±2.5 mmHg降至67.3±2.6 mmHg。在研究组中，无创通气支持使PaO2升高（至76.7±3.0 mmHg；p<0.05），并降低了肺泡-动脉氧分压差（P[A-a]O₂）（从27.2±2.7 mmHg降至17.6±2.3 mmHg；p<0.05）。撤去无创通气支持1小时后，后一种效应仍然存在。相比之下，对照组在整个研究过程中PaO2和P(A-a)O₂均未改变。在整个研究过程中，任何一组的二氧化碳分压（PaCO₂）、通气模式和全身血流动力学均无显著变化。重要的是，无创通气支持并未增加死腔与潮气量之比，也未加重胸膜漏气。
在接受肺切除手术的患者中，使用通气支持系统进行短期无创通气支持可提高肺作为气体交换器的效率，且无明显不良副作用。
