个体化使用呼气末正压治疗重症哮喘

Individualized PEEP in treatment of severe asthma

目的探讨使用呼气末正压(PEEP)治疗重症哮喘的适应性及理想PEEP.方法把42例机械通气的重症哮喘患者分为A、B、C、D组,A组11例为有肺气肿且呼吸频率(RR)＜35次/min,B组16例为有肺气肿且RR≥35次/min者,C组5例为无肺气肿且RR＜35次/min者,D组10例为无肺气肿且RR≥35次/min者.先对4组患者使用2～3cmH 2O的PEEP或不使用PEEP,然后按一定的步骤根据具体情况进行调整,直至理想PEEP.结果A组PEEP适应率为81.8%,理想PEEP平均值为(5.5±3.4)cmH2O,其变异系数(CV)为61.8%;B组PEEP适应率为75.0%,理想PEEP平均值为(4.3±3.1)cmH2O,其变异系数为72.1%;C组PEEP适应率为60.0%,理想PEEP平均值为(3.2±2.5)cmH2O,其变异系数为78.1%;D组PEEP适应率为20.0%,理想PEEP平均值为(2.6±2.1)cmH2O,其变异系数为80.8%.4组总脱机成功率97.6%.结论判别PEEP治疗重症哮喘的适应性及理想PEEP,受是否合并肺气肿和呼吸频率快慢的影响较大,但也受其他诸多因素的影响,故使用PEEP治疗重症哮喘时要高度个体化.

Objective To research the suitability of using positive end-expiratory pressure (PEEP) to treat severe asthma and to explore the ideal value of PEEP.Methods Forty-two patients with severe asthma receiving mechanical ventilation were divided into 4 groups: Group A, B, C and D. Group A (11 cases) were the patients with aeroemphysema and respiration rate (RR) <35/min. Group B (16 cases) were the patients with aeroemphysema and RR ≥35/min. Group C (5 cases) were the patients with no aeroemphysema and RR <35/min. Group D (10 cases ) were the patients with no aeroemphysema and RR ≥35/min. At first, the patients of the 4 groups were given 2~3 cmH2O PEEP or no PEEP and then they were adjusted to ideal PEEP according to specific circumstances step by step.Results In Group A, the rate of suitability to PEEP was 818%, the average ideal PEEP was (5.5±3.4) cmH2O, and the coefficient of variation (CV) was 61.8%,; In Group B, the rate of suitability to PEEP was 75.0%, the average ideal PEEP was (4.3±3.1) cmH2O, and CV was 72.1%; In Group C, the rate of suitability to PEEP was 60.0%, the average ideal PEEP was (3.2±2.5) cmH2O, and CV was 78.1%; In Group D, the rate of suitability to PEEP was 20.0%, the average ideal PEEP was (2.6±2.1) cmH2O, and CV was 80.8%. The total success for using mechanical ventilation of the 4 groups were 97.6%.Conclusion To judge the suitability of using PEEP in treating severe asthma and to use the ideal value of PEEP both are influenced mainly by aeroemphysema and respiration rate, but also by many other factors. It is thus suggested that the use of PEEP in treating severe asthma must be individualized.