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目的:探讨无创正压通气(NPPV)治疗重度支气管哮喘的效果和并发症。方法:70例重度急性哮喘患者随机接受常规治疗(对照组,n=39)或在常规治疗的基础上加用NPPV治疗(治疗组,n=31)。比较两组临床症状、生命体征及血气分析的变化,气管插管率的差异和NPPV相关的并发症。结果:治疗组临床症状迅速缓解,气管插管3.2%明显低于对照组的20.5%(P<0.05)。治疗组HR和RR(4 h和8 h时间点)比对照组改善更明显(P<0.05),治疗组治疗2 h后pH及PaO_2/FiO_3有明显改善(P<0.05),对照组在治疗4 h后才有明显改善(P<0.05)。治疗后,治疗组pH(2 h和4 h时间点)、PaO_2/FiO_2(2 h和8 h时间点)、PaCO_2明显优于对照组(P<0.05)。NPPV相关的不良反应发生率为16.1%,无严重并发症发生。结论:在重度急性哮喘发作的早期,在常规治疗的基础上加用NPPV可迅速改善患者症状,降低气管插管率,改善呼吸窘迫和降低心率,提高患者的呼吸功能。
Objective: To investigate the efficacy and complications of noninvasive positive pressure ventilation (NPPV) in the treatment of severe bronchial asthma. METHODS: Seventy patients with severe acute asthma were randomized to receive either conventional therapy (n = 39 in the control group) or to NPPV (n = 31) on a regular basis. Clinical symptoms, vital signs and changes in blood gas analysis, differences in tracheal intubation rates and NPPV-related complications were compared between the two groups. Results: The clinical symptoms of the treatment group were relieved quickly. The rate of endotracheal intubation was 3.2% lower than that of the control group (20.5%, P <0.05). The improvement of HR and RR in the treatment group (P <0.05) was more obvious than that in the control group at 4 and 8 hours (P <0.05), and the pH and PaO 2 / FiO 3 in the treatment group were significantly improved (P <0.05) After 4 h, there was a significant improvement (P <0.05). After treatment, PaCO 2 in PaO 2 / FiO 2 (2 h and 8 h time points) and PaCO 2 in treatment group were significantly better than those in control group (P <0.05). The incidence of NPPV-related adverse events was 16.1% with no serious complications. Conclusion: In the early stage of severe acute asthma, adding NPPV to conventional treatment can rapidly improve symptoms, reduce tracheal intubation rate, improve respiratory distress, decrease heart rate and improve respiratory function.