摘要
目的评价机械通气治疗重症哮喘急性发作的方法及疗效。方法对2000～2004年兖矿集团兴隆庄煤矿医院呼吸内科收治的16例重症哮喘患者,在内科综合治疗的同时,10例经鼻气管插管,2例先经口插管后又气管切开,4例经面罩机械通气。前者起始模式为同步间歇指令通气(SIMV)+压力支持(PSV),呼吸停止及人机对抗应用镇静剂者为控制/辅助模式,后者为无创正压通气(BiPAP)。低潮气量(6～8ml/kg),慢呼吸频率(8～12次/min),长呼气时间(吸:呼>1∶2),吸气压<25cmH2O,吸气时间0.8～1.0s。待气道阻力下降,症状体征改善,尽早撤机。结果16例患者均抢救成功。平均1.5h症状体征开始改善,63%上机24h症状评分2分,上机平均时间76.2h,治疗后血气指标均恢复正常,与治疗前比较差异有非常显著性意义(P<0.01)。结论机械通气是治疗重症哮喘急性发作的有效方法,掌握适应证,把握上机时机,选择适当的模式和参数,尽早拔管和撤机是治疗成功的关键。
Objective Evaluate the measures and curative effect of the mechanical ventilation curing urgently serious asthma. Methods This title introduces the treatment measures and curative effect of 16 cases that cured in the respiration internal medicine of Xinglongzhuang Coal Mine Hospital from Jan, 2000 to Dec. 2004, At the time of integrated treatment, we practiced nose trachea intubatton for 10 of the 16 cases, oral cavity intubatton and trachea incision for 2 cases, mechanical veil ventilation for 4 cases, To the former we practiced the pattern of synchronized intermittent mandatory ventilation （SIMV） and pressure support ventilation （PSV）, and control/assistance （C/A） pattern when respiration halt, patient -respirator rivalry, applying tranquillizer. To the latter we practiced biphasic intermittent positive airway pressure （BiPAP）. We should remove the respirator when airway resistance declines and symptom ameliorates as followings： LVT： 6 - 8 ml/kg, LRR.. 8 - 12 times/min, LRT： （ E ： I 〉 1 ： 2）, IP 〈 25cmH2 O, IT： 0. 8 - 1.0s. Results As a result, all of the 16 patients were salvaged successfully. Their health begin to ameliorate after average 1.5 hours of average 76. 2 hours using respirator. The symptom of 63 percent of them scored 2 scores after average 24 hours＇ using. They all got their breath again after treatment （ P 〈 0.01 ）. Conclusion Mechanical ventilation is a working measure to cure urgently serious asthma, and it is the key that seizing the adapt symptom, holding the occasion of using respirator, practicing proper pattern and getting right parameters.
出处
《实用心脑肺血管病杂志》
2006年第3期201-203,共3页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
关键词
哮喘
机械通气
气管插管或切开
面罩BIPAP
Asthma
Mechanical ventilation
Trachea intubatton/incision
Veil
Biphasic intermittent positive airway pressure
