无创正压通气治疗急性肺损伤/急性呼吸窘迫综合征的观察

Noninvasive positive pressure ventilation in the patients with acute lung injury/acute respiratory distress syndrome

目的 评价无创正压通气 (NPPV)治疗急性肺损伤 (ALI) /急性呼吸窘迫综合征 (ARDS)患者的临床效果。方法 对 18例ALI/ARDS患者实施NPPV治疗结果进行回顾性总结 ,分析NPPV治疗前后动脉血氧分压 /吸氧浓度 (PaO2 /FiO2 )、呼吸频率 (RR)和心率 (HR)的变化。结果 NPPV治疗成功率为 5 5 6 % (10 / 18) ,8例NPPV治疗失败患者中 7例改用气管插管有创通气 ,总死亡率为 33 3% (6 / 18)。NPPV成功组 5 0 % (5 / 10 )为ALI患者 ,治疗后 1～ 2hPaO2 /FiO2 、RR和HR较治疗前有显著改善。NPPV失败组均为ARDS患者 ,治疗后 1～ 2hPaO2 /FiO2 、RR和HR无明显变化。结论 NPPV对部分ALI/ARDS患者是有效的支持治疗手段 ,尤其是ARDS早期的ALI阶段可考虑选用NPPV。如NPPV治疗失败 ,应及时转换为气管插管有创通气。

Objective To evaluate the effect of noninvasive positive pressure ventilation (NPPV) on treatment of patients with acute lung injury(ALI)/acute respiratory distress syndrome(ARDS).Mothod The outcome of eighteen patients with ALI/ARDS who received NPPV therapy were evaluated.Ratio of partial pressure of arterial oxygen to the fraction of inspired oxygen(PaO 2/FiO 2), respiratory rate (RR) and heart rate(HR) were analyzed in those patients before and after NPPV.Results Success rate of NPPV was 55.6%(10/18).Seven of eight patients due to NPPV failure received endotracheal intubation.Overall mortality rate for the ALI/ARDS patients was 33.3%(6/18).In NPPV success group,50% patients(5/10) belonged to ALI phase,there was obvious improvement of PaO 2/FiO 2, RR and HR within 1～2 hours after NPPV compared with before NPPV.In NPPV failure group, all the patients had ARDS occurrence,there was no statistical difference in PaO 2/FiO 2, RR and HR between after and before NPPV therapy.Conclusions NPPV was effective methods of ventilation support therapy in partial patients with ALI/ARDS.NPPV should be considered as a treatment option for patients with ALI/ARDS,especially in early phase of ALI/ARDS.When NPPV failure occurred,it should be replaced promptly by endotracheal intubation and invasive ventilation.