抄録
高齢者(80歳以上)の開腹術後におけるNPPVの有効性を明らかにする目的で,帰室時から第一病日までBiPAPを施行した群(30名)と酸素マスクのみのno-BiPAP群(29名)で,酸素化能(PaO_2/FiO_2:P/F比)と換気能(PaCO_2),術後心肺合併症,BiPAP合併症,在院日数を遡及的に検討した。P/F比ではno-BiPAP群は術前に比して帰室後,第一病日朝が有意に低下し,BiPAP群が帰室後,第1病日朝でno-BiPAP群より有意に高かった(375.3±88vs291±64.9,348.7±86.8vs279.5±61.8,p<0.05)。PaCO_2は有意差がなかった。心肺合併症発生率ではno-BiPAP群で有意に高かった。これらの結果からNPPVは高齢者開腹手術の術後呼吸管理に有用であることが示唆された。
We introduced noninvasive positive pressure ventilation (NPPV, BiPAP) in elderly patients (over 80 years old) after abdominal surgery for postoperative respiratory care, and retrospectively estimated the effectiveness of NPPV. Thirty patients were allocated to the BiPAP group, and 29 patients to the no-BiPAP group. We measured PaO_2/FiO_2 (P/F ratio) and PaCO_2 at preoperative day, the operative day (after attaching BiPAP), and the 1^<st> postoperative morning (after removing BiPAP), then verified the incidence of cardiopulmonary complications, and postoperative hospital stay between both groups. In no-BiPAP group, the P/F ratio of the operative day and 1St postoperative morning was significantly lower than that of preoperative day. At the operative day and 1st postoperative morning, the P/F ratios of the BiPAP group were significantly higher than those of the no-BiPAP group, respectively (375.3±88 vs 291±64.9, 348.7±86.8 vs 279.5±61.8, p<0.05). There was no significant PaCO_2 difference between the groups. The incidence of cardiopulmonary complications of no-BiPAP group is significantly higher than that of BiPAP group (p<0.05), but there was no significant difference on hospital stay. These results indicated that BiPAP was effective on maintaining oxygenation and reducing cardiopulmonary complications in elderly patients after abdominal surgery.
