心大血管術後の呼吸不全に対する非侵襲的陽圧換気法(NIPPV)の使用経験

Abstract

心大血管術後の呼吸不全に対して,挿管することなくマスクを用いて陽圧換気を行う非侵襲的陽圧換気法(NIPPV)を施行し,良好な結果を得た.症例1:63歳,男性.COPDを合併した弓部大動脈瘤に対して人工血管置換術を施行した.術後5日目に抜管したが,COPDの急性増悪のため,再挿管となった.抜管後の呼吸補助を目的に,術後14日目にNIPPVを開始した.徐々に圧補助を減らし,18日目にNIPPVから離脱しえた.症例2:67歳,男性.狭心症に対して冠状動脈バイパス術を施行した.術翌日に抜管したが,3日目に無気肺による低酸素血症となった.高濃度酸素投与および持続陽圧呼吸目的にNIPPVを開始した.速やかに症状の改善を認め,術後7日目にNIPPVから離脱しえた.NIPPVは心大血管術後の呼吸不全に対して有用であり,積極的に試みてもよいと思われた.

NIPPV provides positive pressure ventilation through a face mask without intubation. We performed NIPPV for 2 patients with acute respiratory failure following cardiovascular surgery. (Case 1) A 63-year-old man, who had had COPD (Hugh-Jones class III), underwent replacement of the aortic arch. He was extubated after 5 days. However, he was re-intubated under controlled ventilation because of deterioration of his respiratory condition. The patient had NIPPV after cxtubation on postoperative day 14 because he was alert and had no cardiovascular compromise. On the 18th postoperative day he was weaned from NIPPV. (Case 2) A 67-year-old man underwent coronary artery bypass surgery. On the next day he was extubated, but he suffered from hypoxemia due to impaired respiratory condition on postoperative day 3. The patient underwent NIPPV instead of conventional mechanical ventilation because his condition was stable except for respiration. Respiratory condition improved quickly and he was weaned from NIPPV on the 7th postoperative day. NIPPV is an effective method for managing patients with acute respiratory failure after cardiovascular surgery.