双水平正压机在急性重度有机磷农药中毒有创通气后脱机过渡中的应用价值

BiPAP machine on the patients with acute severe organophosphorus pesticides poisoning during sequential invasive mechanical ventilation therapy

目的探讨双水平正压（BiPAP）机在急性重度有机磷农药中毒（AOPP）有创通气后脱机过渡中的应用价值。方法急性重度有机磷农药中毒致呼吸衰竭患者100例，均行有创机械通气，随机分常规组（40例）和序贯组（60例）。检测两组患者心肌酶学变化，上BiPAP呼吸机前、后动脉血气，监测心率、血压、脉搏氧饱和度，并监测心率、血压、脉搏氧饱和度计算重新气管插管率。结果两组治疗后心肌酶（CK、CK—MB、AST、LDH）较治疗前均明显下降，差异有统计学意义（P〈0．01）；序贯治疗组患者拔管前及拔管2h后生命体征及动脉血气分析比较差异无统计学意义（P〉0．05）；撤机后序贯治疗组在有创通气时间、总机械通气时间、入住ICU／EICU时间明显缩短（P〈0．05）；呼吸机相关性肺炎（VAP）的发生率两组相似；序贯治疗组重新气管插管率明显低于对照组（P〈0．05）。结论患者对BiPAP呼吸机耐受性好，能够改善AOPP致中间综合征（IMS）的通气功能，并能使常规机械通气顺利脱机，减少重新插管率。

Objective To investigate the value of BiPAP machine on the patients with acute severe organophosphorus pesticides poisoning （ASOPP） during sequential invasive mechanical ventilation therapy. Methods One hundred ASOPP patients with respiratory failure were ventilated through an endotracheal tube. The patients were divided into two groups randomly： traditional group （40 cases） and BiPAP group （60 cases）. The parameters of hemodynamics both before and after the therapy with BiPAP, HR, BP, SpO2 when two hours after oxygen mechanical ventilation, and the reintubation rate was calculated. The traditional group was treated with conventinal therapy alone. Results After therapy CK, CK - MB ,AST and LDH were decreased markedly in the two groups, and there was significant difference （P 〈 0.01 ）. There was no significant difference in respiratory and circulatory parameters between 2 h before and after extubate in BiPAP group （ P 〉 0. 05 ）. Compared with the traditional group, the time of invasive mechanical ventilation, the total time of ventilator assosance and the hospitalized time in ICU/ EICU were decreased markedly （ P 〈 0.05 ） , but the incidence of ventilator associated,pneumonia （VAP） was similar in two groups. Reintubation rate was higher in the traditional group than the BiPAP group （ P 〈 0. 05 ）. Conclusions The toleration of patients for BiPAP machine is better. The BiPAP can improve the ventilation function of IMS caused by ASOPP, make the conventional mechanical ventilation off- line successfully and decrease the reintubation rate.