论文部分内容阅读
用损伤性较小的方法代替气管插管(ETV)治疗高危患者有着特殊意义。研究旨在评价鼻面罩通气(NMV)作为急性呼吸衰竭(ARF)的一线疗法及当ETV禁忌时NMV作为最后治疗手段的价值。患者和方法受试者为有严重呼吸困难(呼吸频率26.68±7.72次/min)、明显低氧血症(PaO_2 5.85±1.62kPa)伴重度高碳酸血症(PaCO_2 9.27±1.89kPa,pH7.28±0.08)和(或)意识障碍(24/30例)而确诊为ARF的30(男14,女16)例患者,平均76(59～93)岁。每例均用塑料面罩以容量型呼吸机通气,其参数根据血气结果调定。前12h及夜间持续通气,白天按照患者情况行间断通气。17例患者用NMV作为最后治疗手段(组1),13例作为一线治疗以避免ETV(组2)。结果 21例患者应用NMV 1h PaO_2迅速改善,数小时后PaCO_2降低,酸中毒、临床表现特别是意识状态亦见好转,而9例立即恶化包括5例死亡(其中4
It is of special significance to use less invasive methods instead of endotracheal intubation (ETV) for high-risk patients. The study aimed to evaluate the value of nasal mask ventilation (NMV) as a first-line therapy for acute respiratory failure (ARF) and as a last resort treatment of NMV when ETV was contraindicated. Patients and Methods Subjects had severe dyspnea (respiratory rate 26.68 ± 7.72 beats / min), significant hypoxemia (PaO 2 5.85 ± 1.62 kPa) with severe hypercapnia (PaCO 2 9.27 ± 1.89 kPa, pH 7.28 ± 0.08) and / or unconsciousness (24/30) and 30 (14 male and 16 female) patients were diagnosed as ARF with an average of 76 (59-93) years. Each case were ventilated with a capacity ventilator with a plastic mask and the parameters were adjusted based on the blood gas results. Ventilation was continued for the first 12 hours and during the night, intermittently during the day according to the patient’s condition. Seventeen patients were treated with NMV as the last resort (Group 1) and 13 as first-line treatment to avoid ETV (Group 2). Results 21 cases of patients with rapid improvement of 1h PaO_2 NMV, PaCO_2 decreased after a few hours, acidosis, clinical manifestations, especially consciousness also improved, and 9 cases of immediate deterioration including 5 deaths (of which 4