采用大型多功能呼吸机无创通气治疗急性肺损伤

Noninvasive ventilatory support in the management of acute lung injury by a complex critical care ventilator

目的 探讨采用大型多功能呼吸机 (大型机 )结合随弃式口鼻面罩和胃肠减压无创通气治疗急性肺损伤 (ALI)。方法 前瞻性连续纳入共 5 4例ALI的患者 ,在常规治疗的基础上 ,结合随弃式口鼻面罩和胃肠减压给予无创通气 ,在此基础上比较大型机和常规无创通气机 (小型机 )的治疗效果 ;而后回顾性比较大型机结合随弃式口鼻面罩和胃肠减压无创通气治疗和人工气道机械通气的疗效。结果 大型机无创通气治疗的效果明显优于小型机 ,并在减少呼吸机相关肺炎、缩短呼吸支持时间等方面优于人工气道机械通气。结论 新式大型急救用呼吸机无创通气结合口鼻面罩、胃肠减压、引流痰液和使用气导等可以从很大程度上实现通气支持 ,促进氧合 ,改善微肺不张和通气 /血流 ,并能替代或避免人工气道的建立。

Objective To explore the use of noninvasive ventilatory support in the management of acute lung injury ( ALI) by a complex critical care ventilator combined with disposable full mask and gastrointestinal decompression.Methods A prospective study which involved 54 patients suffered ALI.All the patients were randomized into 3 groups on a decided protocol and gave noninvasive ventilation.Patients in group A were supported by bilevel pressure ventilator with the mode Auto-Bilevel Positive Airway Pressure; patients in group B were ventilated by a complex critical care ventilator with the mode Pressure Support Ventilation combining Positive End Expiratory Pressure;patients in group C were ventilated also by a complex critical care ventilator but with the mode Biphasic Positive Airway Pressure combining Pressure Support Ventilation.All the ventilatory modes was conducted with full oronasal masks on the condition of gastrointestinal decompression.We collected medical parameters before and after the management that included conventional treatments and noninvasive ventilation.And then we compared retrospectively the effects in a subgroup(acute Respiratory Distress Syndrome,ARDS) of group C with those in conventional invasive mechanical ventilation.Results Parameters in group B and C were better than A while those in group C were the best.Meanwhile the condition of ventilator-associated pneumonias and total ventilatory time was better in the subgroup of group C.Conclusions The use of noninvasive ventilatory support in the management of ALI by a complex critical care ventilator combined with disposable full mask and gastrointestinal decompression can lead to rapid improvement of physiological variables and a reduction in the need for invasive mechanical ventilation.