无创式机械通气与有创式机械通气治疗重症肌无力危象

Comparison of the Clinical Efficacy of Invasive Mechanical Ventilation with Noninvasive BiPAP in Treatment of Myasthenic Crisis

目的比较无创性错落式正压通气(noninvasive bilevel positive ventilation,BiPAP)和有创式机械通气(invasive mechanical ventilation,IV)治疗重症肌无力危象(myasthenic crisis,MC)的临床疗效。方法收集2004-12—2005-12北京医院神经内科住院的40例MC患者临床资料,其中24例行BiPAP治疗,16例行气管插管IV治疗。于治疗前及治疗后1 h和24 h行动脉血气分析并记录心率、呼吸频率。结果使用BiPAP治疗者中18例(75%)避免了行气管插管。两组治疗1、24 h后血气分析、呼吸频率和心率均明显正常化(均P<0.05),两组间差异无统计学意义。IV治疗组呼吸机相关肺炎发生率、抗生素使用率较高,而BiPAP治疗组胃部不适发生率明显为高(P<0.05)。IV治疗组住院费用较BiPAP成功治疗组高(P<0.05)。结论(1)对MC患者可首先采用BiPAP治疗,大部分MC患者可避免气管插管;(2)于MC发生前24 h行BiPAP和IV治疗其疗效相同,BiPAP治疗组并发症较Ⅳ治疗组少。

Objective To compare the clinical efficiency of invasive mechanical ventilation （IV） with that of noninvasive bilevel positive ventilation （BiPAP） in treatment of myasthenic crisis （MC）. Methods 24 patients with MC were managed with BiPAP and 16 with IV. Heart rates （HR）, respiration rate （R） and blood gas were recorded at the beginning of treatment, 1 hour and 24 hours after the initiation of the treatment. The financial costs and side-effects were also recorded. Results The tracheal intubation was avoided in 75% patients with BiPAP. Heart and respiratory rate, blood gas analysis had been normalized at 1 hour and 24 hours after treatment in both groups. There was no significant difference between two groups. The financial costs of hospitalization was greatly lower in BiPAP group than that of IV group （P〈 0.05） . The ventilation associated pneumonia （VAP） occurred more frequently in IV group than in BiPAP group （P〈0. 05）. The gastrectasia was more common in BiPAP group than in IV group. Conclusions （1） The tracheal intubation treatment could be avoided in most patients with MC, if the BiPAP was initiated within 24 hours after onset of MC. （2） The clinical efficiency was quite similar and the side effects were much less in BiPAP group than that in IV group.