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为探讨机械通气在SARS病人治疗中的应用,对重症SARS病人经一般面罩、鼻导管吸氧治疗后仍无明显改善者,改用机械通气。根据情况采用无创呼吸机通气或行气管内插管/气管切开造口后进行有创机械通气。结果220名SARS病人重症者131例,进行机械通气者32例,占全组病人的14.55%,占重症病人的24.43%。仅用无创机械通气者24例,占机械通气病例的75%,占重症病例的18.32%。有创机械通气者8例,占机械通气病例的25%,占重症病例的6.11%。其中气管插管6例,占机械通气病例的18.75%,占重症病例的4.58%;气管切开造口3例(其中1例先行气管插管,后又行气管造口),占机械通气病例的9.38%,占重症病例的2.29%。机械通气者中死亡16例,占全组病例的7.27%,占重症病例的12.21%,占机械通气病例的50%。气管插管6例中,死亡5例,占83.33%;改善、痊愈者仅1例,占16.67%。气管造口3例,均死亡。重症病人未进行机械通气者99例,占重症病例的75.57%,其中死亡3例,占3.03%;改善、痊愈者96例,占96.97%。机械通气者中,并发气胸、纵隔气肿或皮下气肿者共7例,占机械通气者的21.88%。提示无创机械通气在重症SARS病人治疗中有积极意义;但有创机械通气应慎用。气管切开造口术对其治疗无特殊积极意义,气管插管的适应证宜严格掌握,插管应在麻醉下实施。
To explore the application of mechanical ventilation in the treatment of SARS patients, severe SARS patients after general mask, nasal catheter oxygen therapy still no significant improvement, use mechanical ventilation. Non-invasive ventilator ventilation or endotracheal intubation / tracheostomy may be used to perform invasive mechanical ventilation following the condition. Results Among the 220 SARS patients, 131 cases were severe and 32 cases were mechanically ventilated, accounting for 14.55% of all patients and 24.43% of severe patients. Only non-invasive mechanical ventilation in 24 cases, accounting for 75% of mechanical ventilation cases, accounting for 18.32% of severe cases. 8 cases of invasive mechanical ventilation, mechanical ventilation accounted for 25% of cases, accounting for 6.11% of severe cases. Among them, 6 cases of tracheal intubation accounted for 18.75% of cases of mechanical ventilation, accounting for 4.58% of severe cases; 3 cases of tracheostomy (including 1 case of tracheal intubation and tracheostomy) accounted for cases of mechanical ventilation Of the 9.38%, accounting for 2.29% of the severe cases. Mechanical ventilation in the death of 16 cases, accounting for 7.27% of the total cases, accounting for 12.21% of severe cases, accounting for 50% of cases of mechanical ventilation. Tracheal intubation in 6 cases, 5 patients died, accounting for 83.33%; improvement, recovery in only 1 case, accounting for 16.67%. Tracheostomy in 3 cases, all died. Severe patients without mechanical ventilation in 99 cases, accounting for 75.57% of severe cases, of which 3 cases died, accounting for 3.03%; 96 cases improved, 96 cases were cured. Mechanical ventilation, complicated with pneumothorax, mediastinal emphysema or subcutaneous emphysema were a total of 7 cases, accounting for 21.88% of those with mechanical ventilation. Prompt non-invasive mechanical ventilation in the treatment of critically ill patients with SARS has a positive meaning; but invasive mechanical ventilation should be used with caution. Tracheotomy ostomy for its treatment no special positive significance, indications for tracheal intubation should be strictly controlled, intubation should be implemented under anesthesia.