应用机械通气治疗危重哮喘13例临床分析

Mechanical ventilation in the treatment of acute severe bronchial asthma-analysis of 13 cases

目的 评价机械通气治疗急性发作危重症哮喘的方法及疗效。方法 对 2 0 0 1- 0 1～ 2 0 0 3- 0 6沈阳军区总医院呼吸科收治的 2 2 8例重度和危重哮喘中 13例危重型哮喘患者 ,在内科综合治疗同时 12例经气管插管 ,1例经面罩行机械通气 ,前者起始模式为同步间歇指令通气 +压力支持 ,应用静脉肌松剂者为控制 /辅助模式 ,后者为持续正压通气 +压力支持。低潮气量 (6～ 8mL/kg)、慢呼吸频率 (10～ 12 /min) ,长呼气时间 (吸∶呼 >1∶2 ) ,吸气压 <2 5cmH2 O(1cmH2 O =0 0 98kPa) ,吸气时间 0 7～ 1 0s,气道阻力下降 ,症状体征改善 ,尽早撤机。结果 13例患者均抢救成功 ,平均 1 2 5h症状体征开始改善 ,上机 2 4h症状评分≤ 2分 ,上机平均时间 5 0 1h ,治疗后血气分析指标均恢复正常 ,最高呼气峰流量 (PEF)值显著增高 (P <0 0 1)。结论 机械通气是治疗急性发作危重症哮喘的有效方法 ,把握适应证 ,适当的模式和参数 ,尽早拔管和停机是成功的关键。

Objective To evaluate the method and effect of mechanical ventilation in the treatment of acute severe bronchial asthma.Methods 13 cases in 228 cases of acute severe bronchial asthma during Jan 2001 and Nov 2004 were performed mechanical ventilation together with general medical treatment at the same time.The ventilation mode of 12 cases of mechanical ventilation via tracheal cannula was A/C and SIMV+PSV (VT 6～8 mL/kg,RR 10～12 per minute,I/E>1∶2,inspiratory press<25cmH\-2O,inspiratory duration 0.7～1.0 s). The ventilation mode of 1 case of mechanical ventilation was BIPAP via face mask.Results 13 patients were treated successfully.The amelioration of symptoms and signs started 1.25 hours after mechanical ventilation.The symptom score was not more than two 24 hours after mechanical ventilation.The duration of mechanical ventilation was 50.1 hours.The analysis of blood gas was normal after treatment.The PEF was increased significantly (P<0.01).Conclusion Mechanical ventilation is an effective method to treat acute severe bronchial asthma.Attention should be paid to proper marker, mode and parameter.