无创正压通气在多发伤并发ALI/ARDS中的临床应用

Clinical evaluation of noninvasive positive pressure ventilation in multiple injury patients with acute lung injury and acute respiratory distress syndrome

目的:探讨使用无创正压通气(Noninvasive positive pressure ventilation,NIPPV)治疗多发伤并发急性肺损伤/急性呼吸窘迫综合征(Acute lung injury/acute respiratory distress syndrome,ALI/ARDS),总结双水平气道正压通气呼吸模式的临床应用。方法:回顾性分析75例多发伤并发ALI/ARDS患者使用NIPPV或有创机械通气(Invasive mechanical ventilationI,MV)的情况,比较两种通气方式治疗前及治疗后2 h动脉血气分析变化及机械通气时间。结果:NIPPV40例,有创通气35例。无创通气组及有创通气组通气2 h后病人动脉血氧分压(Arterial partial pressure of oxygen,PaO2)及血氧饱和度(Oxygen saturation,SaO2)较通气前明显提高(P<0.000 1)。无创通气组中5例无创通气3～5 d(平均4.2 d)后改IMV,4例因手术需全麻,先予以IMV 20～36 h后改为无创机械通气。35例无创通气3～18 d[平均(8±5.5)d]成功脱机,无1例死亡。IMV组通气5～20 d脱机[平均(9±5.5)d],无1例死亡。两组机械通气时间比较无统计学意义(P>0.05)。两组间动脉血气分析治疗前、治疗后变化比较无统计学意义(P>0.05)。结论:多发伤后合并ALI/ARDS早期应用NIPPV治疗,采用双水平气道正压通气的呼吸模式,不仅可取得与IMV治疗相同的效果,而且能减少并发症,提高病人的舒适性。

Objective：To explore the importance of noninvasive positive pressure ventilation（NIPPV） in treating patients suffered from multiple injury accompanied with acute lung injury（ALI）/acute respiratory distress syndrome（ARDS）,and summarize the clinical usage of bi-level airway pressure ventilation mode in the treatment.Methods：The 75 cases with multiple injury complicated with ALI/ARDS were analyzed retrospectively and the following two groups were obtained：the positive pressure ventilation group,in abbreviation NIPPV,and the invasive mechanical ventilation group,in abbreviation IMV.The changes of arterial blood gas individually before and after 2 h treatment and the duration of using ventilation were compared between the two groups.Results：40 cases were enrolled into NIPPV group,and 35 cases belong to IMV group.The arterial partial pressure of oxygen（PaO2） and arterial oxygen saturation（SaO2） had significantly improved after 2 h NIPPV or IMV treatment（both P 0.000 1）.5 patients changed to IMV after 3～5 days NIPPV（average=4.2 d）according to their conditions.4 patients who needed general anesthesia operations were given IMV for 20～36 h,then were changed to NIPPV.Duration of using NIPPV were 3～18 d（average=（8±5.5） d）,and duration of using IMV were 5～20 d（average=（9±5.5） d）.The changes of arterial blood gas showed no significant difference between NIPPV and IMV at the statistic level of P0.05.No patient died in two groups.Conclusion：The use of bi-level airway pressure ventilation on NIPPV mode in early stage of multiple injury patients with ALI/ARDS not only has same effect as using IMV,but also can reduce complications and improve patients＇ comfortableness.