危重哮喘机械通气治疗的应用

Mechanical ventilation for acute severe bronchial asthma

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2001年1月至2004年11月收治的246例急性发作危重哮喘中15例危重型哮喘患者,在内科综合治疗同时13例经气管插管,起始模式为同步间歇指令通气+压力支持,应用静脉内注射肌松剂者为控制/辅助模式,低潮气量(6～8ml/kg),慢呼吸频率(10～12次/min),长呼气时间(吸:呼>1:2),吸气压<25cmH2O,吸气时间0.7～1.0秒。2例经面罩行机械通气,为双水平正压通气。结果15例患者均抢救成功,平均1.25小时症状体征开始改善,机械通气24小时症状评分≤2分,平均机械通气时间59.8小时,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<0.01)。结论机械通气是治疗急性发作危重症哮喘的有效方法,应注意把握适应证,适当的模式和参数。

Objective To evaluate the method and efficacy of mechanical ventilation treating acute severe bronchial asthma.Methods Fifteen cases in 246 cases of acute severe bronchial asthma during Jan 2001 and Nov 2004 were done mechanical ventilation and general medical treatment at the same time.The ventilation mode of 13 cases of mechanical ventilation via tracheal cannula were A/C and SIMV+PSV (VT 6-8ml/kg,RR 10-12 per minute,I/E>1:2,inspiratory press<25cmH 2O,inspiratory duration 0.7s～ 1.0s).The ventilation mode of 2 cases of mechanical ventilation was BIPAP via face mask.Results Fifteen patients were treated successfully.The amelioration of symptoms and signs started 1.25 hour after mechanical ventilation.The symptom score was not more than two 24 hours after mechanical ventilation.The duration of mechanical ventilation was 59.8 hours.The parameter of blood gas analysis was normal and PEF was increased significantly (P< 0.01) after treatment.Conclusions Mechanical ventilation was effective method to treat acute severe bronchial asthma.It should be noticed on proper indication,mode and parameter.