吸入一氧化氮并环甲膜穿刺气管内注液治疗重症哮喘

Inhaled nitric oxide combined with endotracheal liquid injection via cricothyroid membrane puncture for the treatment of patients with severe asthma

目的：探讨在双相气道正压（ＢｉＰＡＰ）呼吸机通气下治疗吸入外源性一氧化氮（ＮＯ）并用环甲膜穿刺间断气管内液体注入抢救重症哮喘的治疗作用。方法：２２例患者随机分成２组，ＢｉＰＡＰ呼吸机治疗合并吸入外源性ＮＯ和环甲膜穿刺间断气管内液体注入为治疗组（１２例）；单用ＢｉＰＡＰ呼吸机治疗为对照组（１０例）。２组病例均大量快速输液纠正脱水和加用激素（地塞米松）治疗，并记录治疗后临床症状及体征改善所需时间和治疗前及治疗后１２小时血气变化。结果：治疗组与对照组比较，临床症状改善（开始安静，出汗减少，能平卧，呼吸变深变慢）所需时间明显缩短（Ｐ均＜０．０５）；体征改善（哮鸣音减少，哮鸣音消失，心率下降，心率平稳）所需时间明显缩短（Ｐ均＜０．０５）；治疗后１２小时动脉氧分压（ＰａＯ２）明显升高（Ｐ＜０．０５），动脉二氧化碳分压（ＰａＣＯ２）明显下降（Ｐ＜０．０５）。结论：重症哮喘患者吸入ＮＯ并用ＢｉＰＡＰ呼吸机和环甲膜穿刺间断气管内注入液体可以扩张支气管，稀释痰液，通畅呼吸道；此方法是抢救重症哮喘的一个有效方法。

Objective:To investigate the effect of inhaled nitric oxide (NO) combined with bilevel positive airway pressure(BiPAP) ventilation and endotracheal liquid injection via cricothyroid membrane puncture for the treatment of patients with severe asthma.Methods:Patients were randomly divided into 2 groups:treatment group (n=12,BiPAP ventilation combined with inhaled NO and endotracheal liquid injection via cricothyroid membrane puncture) and control group (n=10,only BiPAP ventilation).All patients were treated by fast fluid infusion and corticosteroids.The time for improvement of clinical symptoms and signs was recorded,and blood gas was observed before as well as at 12 hours after treatment.Results:The time for improvement of clinical symptoms and signs (e.g.slow and deep breath,disappearance of wheeze sound,reduction in heart rate,and stabilization of heart rate) in treatment group was significanttly decreased compared with control group (all P<005).In treatment group,PaO2 value was markedly increased (P<005),while PaCO2 was decreased (P<005) compared with controls at 12 hours following treatment.Conclusions:Inhaled NO combined with BiPAP ventilation and endotracheal liquid injection via cricothyroid membrane puncture can dilate bronchus,dilute sputum,and clear airway,and it may be a useful method for the treatment of patients with severe asthma.