重度哮喘并呼吸衰竭30例无创通气治疗及同步护理

Non-invasive ventilation and synchronic nursing care in the treatment of 30 patients with severe asthma combined with respiratory failure

目的:总结无创正压通气(NIPPV)治疗重度哮喘并呼吸衰竭患者过程中的监测和护理体会。方法:回顾分析30例重症哮喘合并呼吸衰竭患者在用药物治疗基础上加用无创通气治疗,选择鼻(面)罩接双水平正气道压(Bi-PAP)呼吸机;在治疗过程中全程护理并追踪患者最后转归。结果:本组治疗22例有效(占73.33%),临床症状明显改善,血气分析中pH、PaO2、PaCO2等参数有显著性改变(P<0.05),避免了建立人工气道来改善通气。结论:BiPAP压力支持通气能有效地纠正低氧血症,二氧化碳潴留,提高重症哮喘的抢救成功率;正确掌握适应症和操作程序,严密监测并防治并发症,特别开始6～12h内有专人监护是确保成功应用NIPPV的重要环节。

Objective： To evaluate the monitoring and nursing experiences in the treatment of patients with severe asthma combined with respiratory failure by non - invasive positive pressure ventilation （ NIPPV ）. Methods. NIPPV treatment of 30 patients with severe asthma combined with respiratory failure based on medication was retrospectively analyzed. The selected nasal （ facial ） mask was connected to bi - level positive airway pressure （ BiPAP ） ventilator and nursing care was conducted throughout the treatment and the outcome of the treatment was followed up. Results ： The treatment was effective in 22 cases （ accounting for 73.33% ） and clinical symptoms obviously improved, pH, PaO2 , PaCO2 and other parameters were significantly changed （ P 〈 0.05 ）, avoiding the establishment of artificial airway to improve ventilation. Conclusion ： BiPAP pressure support ventilation can effectively correct hypoxemia, carbon dioxide retention and improve the success rate of rescuing severe asthma; proper understanding of indications and operating procedures, prevention of complications and the particular monitoring in the first 6 - 12 hours are the important links to ensure the successful application of NIPPV.