双水平无创正压通气对急性肺损伤的治疗价值

Clinical effect of bi-level positive airway pressure ventilation on acute lung injury

目的探讨双水平无创正压(BiPAP)通气应用于急性肺损伤(ALI)的可行性。方法13例ALI患者应用BiPAP通气治疗,观察不同时间(通气前、通气2h、通气12h和撤机后)PaO2、PaCO2、pH、呼吸频率(RR)及辅助呼吸肌动用评分的变化,以及住院气管插管率、死亡率和无创正压通气时间。结果应用BiPAP通气治疗ALI,在通气2h可提高PaO2(70·66±9·80)mm Hg比(58·12±10·68)mm Hg,P<0·05,改善pH(7·39±0·04)比(7·41±0·08),P<0·05。通气治疗12h后,PaCO2、RR和辅助呼吸肌动用显著改善PaCO2:(36·43±6·62)mm Hg比(30·70±8·06)mm Hg;RR:(22·6±8·0)次/min比(40·2±7·6)次/min;辅助呼吸肌动用评分:(2±1)分比(3±2)分;P均<0·05。病情恶化气管插管1例,住院死亡2例。结论对ALI患者积极应用BiPAP通气治疗可改善缺氧,降低呼吸频率,改善呼吸肌疲劳,可能降低发展至急性呼吸窘迫综合征而增加的气管插管或死亡率。

Objective To evaluate the clinical effect of bi-level positive airway pressure（BiPAP） ventilation on patients with acute lung injury（ALI）. Methods Thirteen patients with ALI were underwent BiPAP ventilation on the basis of routine treatment. Changes of PaO2, PaCO2, arterial pH, respiratory late（RR） and score of the accessory respiratory muscle use were measured at different time points（before ventilation,2 hours and 12 hours after ventilation, and after weaning, respectively）. Meanwhile, the percentage of invasive mechanical ventilation（IMV）, mortality and ventilation duration were recorded. Results PaO2 and pH of the patients with ALI were improved siguificantly 2 hours after BiPAP ventilation [ （70.66±9.80）mm Hg vs （58.12 ± 10.68）mm Hg, P 〈 0.05; （7.39 ± 0.04） vs （7.41 ± 0.08）, P 〈 0.05]. PaCO2, RR and score of accessory muscle use were improved 12 hours after ventilation [ PaCO2 ： （ 36.43 ± 6.62 ） mm Hg vs （ 30.70 ± 8.06） mmHg; RR： （ 22.6 ± 8.0）/min vs （40.2±7.6）/rain;score of accessory muscle use：（2 ± 1） vs （3±2）;all P〈0.05].One case received IMV because of worsened disease, and two cases died. Conclusion BiPAP ventilation can improve patients＇ oxygenation,reduce RR, and relieve respiratory muscle fatigue of the patients with acute lung injury, maybe futher reduce the requirement for IMV and mortality in advanced disease, ie. acute respiratory distress syndrome.