论文部分内容阅读
目的探讨无创正压通气(NIPPV)在救治严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)致呼吸衰竭患者中的治疗作用。方法采用临床观察研究的方法,对太原地区五所三级综合医院2003年3月至2003年5月所收治的临床确诊的304例SARS患者的临床资料及NIPPV治疗情况进行分析。结果304例SARS患者中接受NIPPV治疗的有44例(14.5%),男性25例,女性19例,年龄(46±14)岁。有基础疾病者11例(25%)。应用NIPPV的平均时间(20±5)d。其中34例(77%)患者成功撤机,康复出院;3例患者(7%)因病情加重转为有创机械通气治疗;7例(16%)患者死亡。死亡组患者与存活组患者相比,年龄较大、有基础疾病者和并发症人数的比例增高(P<0.05)。应用NIPPV通气治疗后,患者脉搏容积血氧饱和度(SpO2)、动脉血氧分压(PaO2)明显改善,呼吸频率(RR)、心率(HR)减慢,动脉血二氧化碳分压(PaCO2)回升,与通气前比较各指标的变化差异有显著性(P<0.05)。但pH值变化不明显。13例患者出现恐惧、配合差、鼻咽部干燥及胃胀气,未发现气压伤及医务人员在应用NIPPV过程中感染SARS。结论应用NIPPV辅助通气可明显改善SARS患者的呼吸困难症状、纠正低氧血症,显著降低对气管插管的需求。NIPPV应用的时机、患者的年龄、既往健康状况可能是影响NIPPV预后的主要危险因
Objective To investigate the therapeutic effect of noninvasive positive pressure ventilation (NIPPV) in the treatment of patients with respiratory failure caused by severe acute respiratory syndrome (SARS). Methods The clinical data and clinical data of 304 patients with SARS clinically diagnosed from March 2003 to May 2003 in five tertiary general hospitals in Taiyuan were analyzed by clinical observation method. Results Forty-four patients (14.5%) were treated with NIPPV in 304 SARS patients. There were 25 males and 19 females, aged 46 ± 14 years. Eleven patients had underlying diseases (25%). The mean time to use NIPPV was (20 ± 5) days. Among them, 34 patients (77%) were weaned successfully and were discharged from hospital. Three patients (7%) were switched to invasive mechanical ventilation due to exacerbations. Seven patients (16%) died. In the death group, the proportion of the older, those with underlying diseases and complications was higher than those in the survival group (P <0.05). After NIPPV ventilation, pulse volume oxygen saturation (SpO2) and arterial oxygen pressure (PaO2) were significantly improved, respiratory rate (RR), heart rate (HR) and arterial carbon dioxide partial pressure , There was significant difference between each index before ventilation and ventilation (P <0.05). However, the pH change is not obvious. Thirteen patients had fears, poor cooperation, nasopharyngeal dryness and flatulence, no barotrauma and medical workers infected with SARS during NIPPV application. Conclusion NIPPV-assisted ventilation can significantly improve the symptoms of dyspnea in SARS patients, correct hypoxemia, and significantly reduce the need for endotracheal intubation. The timing of NIPPV application, the patient’s age, and previous health status may be the major risk factors for NIPPV prognosis