无创双水平正压通气治疗急性重症哮喘64例临床分析

BiPAP for 64 cases of severe bronchial asthma

目的评价无创双水平正压通气治疗急性重症哮喘的方法及疗效。方法对2000年01月至2005年03月我院呼吸科收治的64例急性重症哮喘患者，在内科综合治疗的同时行口鼻面罩无创双水平正压通气。采用同步／时间比例（S／TD）通气模式，吸气压（IPAP）16—26cmH2O（1cmH2O=0．098kPa），呼气压（EPAP）4～8cmH2O。观察患者的症状、体征、血气改变等指标。结果64例患者中，5例病情加重改为经鼻气管插管，行有创机械辅助通气；3例放弃治疗；1例死亡；余55例抢救成功（抢救成功率85．9％）。平均无创双水平正压通气1．55h后，症状、体征及血气分析等开始改善，24h症状评分均≤2分，平均上机时间76．5h。结论无创双水平正压通气是治疗急性重症哮喘的有效方法，对急性重症哮喘患者，在内科综合治疗的基础上尽早使用此法，可减少并发症，挽救病人生命。

Objective To investigate the effect and method of BiPAP in treating athma with acute exacerbation. Methods A total of 64 cases of acute severe bronchial asthma admitted by our hospital during Jan 2000 to Mar 2005 underwent mechanical ventilation with general medical treatment. The ventilation mode of STD BiPAP was adopted, IPAP was 16 -26 cmH2O, EPAP was 4 -8 cmH2O. The symptoms, signs and the arterial blood gas of the patients were recorded and analyzed. Results Among 64 patients, 5 were transformed to receive the nasotracheal tube owing to exacerbated conditions, assisted by traumatic mechanical ventilation; 3 gave up treatment; 1 died; 55 were rescued, with the survival rate of 85.8%. The increase of PaO2, pH and the decrease of PaCO2 and the amelioration of symptoms and signs started 1.55 h after ventilation in BiPAP. The symptom score was less than 2 after mechanical ventilation for 24 h. The duration of mechanical ventilation was 76.5 h in average. Conclusion Ventilation in BiPAP is an effective method for acute severe bronchial asthma, which can save the patients＇life and decrease the complications based on the combined medical therapy.