早期适时呼吸支持策略在急性中毒呼吸衰竭中的应用

Application of early timely respiratory support strategies in acute poisoning patients with respiratory failure

目的探讨早期适时呼吸支持在急性中毒所致急性呼吸衰竭救治中的临床应用价值。方法对26例急性重症中毒所致急性呼吸衰竭患者采用早期适时呼吸支持策略,观察治疗模式选择、通气指标、血压、心率、血气指标、A-PACHEII评分的动态变化以及病情转归。结果呼吸支持模式分别为SIMV+PSV+PEEP 16例,BiPAP+PSV+PEEP 6例,CPAP+PSV 4例,所有患者上机时间1～11d,平均(3.40±2.05)d,其中6例在72h后行气管切开人工机械通气。治愈出院23例,死亡3例,治愈者均一次成功撤机。全部患者在给予人工呼吸支持前APACHEII评分11～35,平均为16.53±4.89;动态APACHEII评分在治愈者第1～3天有明显下降。结论实施早期适时呼吸支持策略将有助于提高急性重症中毒伴呼吸衰竭患者的抢救成功率,改善患者预后。

Objective To explore the clinical effects of early timely respiratory support in the rescue of acute respiratory failure caused by acute poisoning. Methods Timely respiratory support strategies was applied early in 26 patients with acute respiratory failure caused by acute critical poisoning, and observed the dynamic change of the choice of treatment mode, ventilation indexes, blood pressure, indexes of blood gas analysis, and APACHE Ⅱ scores, and observed the prognosis. Resu Its The synchronous intermittent mechanical ventilation （SIMV） ＋ pressure support ventilation （PSV） ＋ positive end-expiratory pressure （PEEP） mode was used in 16 patients, the bi-level positive airway pressure （BiPAP） ＋PSV＋positive end-expiratory pressure （PEEP） mode was used in 6 patients, and the continuous positive airway pressure （CPAP）＋PSV mode was used in 4 patients. The ventilation time was 3.40±2.05 （1-11） days. Six patients underwent tracheotomy and artificial mechanical ventilation 72 hours later. Twenty-three patients were cured and discharged, and 3 cases died. All the cured cases weaned ventilator successfully once. The APACHE Ⅱ scores of all the patients before artificial respiratory support was 16.53±4.89 （11-35）. The dynamic APACHE Ⅱ scores of the cured patients dropped obviously on the first to the third day. Conc lus ion Applying timely respiratory support strategies early can increase the rescue successful rate of the acute critical poisoning patients with respiratory failure, and improve the prognosis.