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无创机械通气在肾移植术后重症肺部感染合并急性呼吸衰竭中的应用 被引量:10

Noninvasive mechanical ventilation in kidney transplant recipients with severe pneumonia and acute respiratory failure
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摘要 目的探讨无创机械通气(NIV)在救治肾移植术后重症肺部感染合并急性呼吸衰竭中的价值。方法收集13例肾移植术后重症肺部感染患者进行NIV的临床资料,回顾性分析NIV前后缺氧的改善情况、并发症及转归等。结果13例患者使用了机械通气,1例仅用有创机械通气(气管插管);12例采用NIV:6例仅用NIV,另6例先采用NIV,后改用有创机械通气。所有患者均能较好耐受。NIV使用1 h后,平均氧合指数较治疗前有明显提高。3例(25%)气体交换获得持续改善,避免了气管插管并最终存活出院,其余病例死亡。1例(8.3%)出现气胸和纵隔气肿。结论NIV可用于肾移植术后重症肺部感染合并急性呼吸衰竭的早期呼吸支持治疗,能有效改善缺氧,耐受性好,并发症少,为原发病的治疗赢得了时间。 Objective To evaluate the clinical value of noninvasive mechanical ventilation(NIV) in the patients with severe pneumonia and acute respiratory failure (ARF) after renal transplantation. Methods All clinical data ( 14 cases) were analyzed retrospectively. The main analyzed parameters included improvement of hypoxemia before and after NIV,complications and prognosis.Result Mechanical ventilation was applied in 13 cases in which one case received tracheal intubation only, 6 cases received NIV only, and 6 cases received sequential invasive and noninvasive ventilation. The NIV was well tolerated by all patients. Within the first hour of NIV,the ratio of the PaO2 to the fraction of inspired oxygen (FiO2) were improved in all patients. Sustained improvement in gas exchanges was observed in 3 patients (25%) who avoided endotracheal intubation and survived while other patients died. Ventilation associated pneumothorax and mediastinal emphysema developed only in one case. Conclusions As an early appraoch of respiratory support NIV is effective in some cases with severe pneumonia and ARF after renal transplantation with well tolerance and safety.
出处 《中国呼吸与危重监护杂志》 CAS 2006年第4期260-263,共4页 Chinese Journal of Respiratory and Critical Care Medicine
关键词 无创机械通气 肾移植术后 重症肺炎 急性呼吸衰竭 Noninvasive mechanical ventilation Post-renal transplantation Severe pneumonia Acute respiratory failure
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