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目的总结分析重症支气管哮喘患者运用机械通气的临床效果,探讨患者启用人工机械通气的适应证和最佳方案。方法选取2013年1~10月,本院呼吸内科重症监护室收治的重症支气管哮喘患者72例。将符合条件的患者进行通气前准备,如运用镇静剂、肌松药、抑制腺体分泌等,采用呼气末正压通气(PEEP)+压力控制-同步间歇指令通气(PC-SIMV)方案,观察记录患者病情变化,待症状好转,相关检查指标恢复后逐渐撤机,比较治疗前和机械通气24小时后患者血气分析和临床症状改变。结果 72例患者在1周内依次撤机,病情明显好转,机械通气治疗后,患者pH、动脉氧饱和度(SpO2)、动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)较治疗前明显改善,其差异有显著性(P<0.05)。患者神智、呼吸频率、紫绀、肺部哮鸣音情况改善,仅5例患者出现声音嘶哑等上呼吸道损伤症状。结论重症支气管哮喘患者合理运用机械通气可以快速有效缓解呼吸困难症状,对避免电解质紊乱、肺性脑病、呼吸性酸中毒等并发症有明显帮助,当药物治疗无明显疗效时,推荐及早使用。
Objective To summarize and analyze the clinical effect of using mechanical ventilation in patients with severe bronchial asthma and discuss the indications and the best plan of artificial ventilation for patients. Methods From January to October 2013, 72 patients with severe bronchial asthma admitted to the Respiratory Medicine Intensive Care Unit of our hospital were selected. The eligible patients were ventilated before preparation, such as the use of sedatives, muscle relaxants, inhibition of glandular secretion, using positive end expiratory pressure (PEEP) + pressure control - synchronized intermittent mandatory ventilation (PC-SIMV) The patient’s condition was recorded and the symptom was improved. The relative indexes of examination were gradually weaned after recovery, and the blood gas analysis and clinical symptoms of the patients were compared before treatment and 24 hours after mechanical ventilation. Results 72 patients underwent weaning in one week and their condition improved obviously. After mechanical ventilation, the patients’ pH, arterial oxygen saturation (SpO2), arterial oxygen pressure (PaO2) and arterial carbon dioxide partial pressure (PaCO2) Significantly improved, the difference was significant (P <0.05). Patients with mental, respiratory rate, cyanosis, pulmonary wheeze improved, only 5 patients with hoarseness and other symptoms of upper respiratory tract injury. Conclusion The rational use of mechanical ventilation in patients with severe bronchial asthma can quickly and effectively alleviate the symptoms of dyspnea. It is helpful to avoid complications such as electrolyte imbalance, pulmonary encephalopathy and respiratory acidosis. It is recommended to be used as early as possible when there is no obvious curative effect.