无创通气辅助治疗严重急性呼吸综合征急性呼吸衰竭的回顾分析

Noninvasive Ventilation for Treatment of Acute Respiratory Failure Secondary to Severe Acute Respiratory Syndrome

目的探讨严重急性呼吸综合征(SARS)所致急性呼吸衰竭患者接受无创通气治疗对预后的影响。方法在广东省严重急性呼吸综合征数据库中筛选出资料较完整的患者127例。在患者达到ALI/ARDS诊断标准时,根据患者通气治疗情况分为未通气组(n=58)、无创通气组(n=55)和有创通气组(n=14)。追踪未通气组和无创通气组患者接受通气治疗的情况。分别以发展为ARDS和死亡为应变量作多因素回归分析。对无创通气治疗成功与失败患者作多因素回归分析。结果达到ALI/ARDS标准时,无创通气组与未通气组患者比较病情较重,发展至ARDS的比例较高(P<0.01);有创通气组患者死亡率较高(P<0.01)。58例未通气组患者中,一直未使用通气治疗45例,改用无创通气6例,改用有创通气7例。55例无创通气组患者中,改用有创通气15例。61例使用过无创通气的患者与45例未通气患者相比病情较重,从ALI发展为ARDS可能性较大(P<0.01),死亡率无明显差异(P>0.05)。继续无创通气的患者(n=40)与一直未通气患者(n=45)相比病情较重,从ALI发展为ARDS可能性较大(P<0.01),改用有创通气患者(n=22)死亡率较高(P<0.01)。达到ALI/ARDS标准时接受了无创通气治疗的患者55例,15例改用有创通气治疗,两组患者多因素回归提示年龄有显著差异(P<0.01),年龄越大无创改有创通气的几率越高。结论 SARS患者达到ALI/ARDS标准时,接受通气治疗的患者病情较重,从ALI发展为ARDS可能性较大,但早期应用无创通气对死亡率无显著影响;大部分能耐受无创通气的患者可避免气管插管,特别是相对年轻的患者,但须把握好从无创转有创的时机和适应证。

Objective To investigate the effects of noninvasive ventilation for the treatment of acute respiratory failure secondary to severe acute respiratory syndrome（SARS）.Methods 127 patients with complete information were collected from the database of SARS in Guangdong province,who were all consistent with the ALI/ARDS diagnostic criteria.The patients were divided into three groups depending on ventilation status,ie.a no-ventilation group,a noninvasive ventilation group,and a mechanical ventilation group.The outcome of ventilation treatment was followed up.Multi-factor regression analysis was conducted to analyze the relations of ventilation treatment with ARDS and mortality,and factors associated with success of noninvasive ventilation.Results As soon as the patients met the diagnostic criteria of ALI/ARDS,the patients in the noninvasive ventilation group were in more serious condition and had a higher proportion of ARDS compared with the no-ventilation group（P0.01）.The patients in the mechanical ventilation group had a higher mortality rate（P0.01）.6 and 7 patients in the no-ventilation group had noninvasive ventilation and invasive ventilation thereafter,respectively.15 patients in the noninvasive group switched to invasive ventilation.Compared with the patients without ventilation（n=45）,the patients receiving noninvasive ventilation（n=61） were in more serious condition and at higher risk of developing ARDS（P0.01）,but the mortality was not different between them（P0.05）.The patients who continued to receive noninvasive ventilation（n=40） were in more serious condition,and at higher risk of developing ARDS compared with the patients without ventilation（n=45）（P0.01）.15 patients in the noninvasive group who switched to invasive ventilation were older than those patients continuing noninvasive ventilation.Conclusions For SARS patients fulfilling the ALI/ARDS criteria,the patients underwent noninvasive ventilation are more severe,run a higher probability of developing ARDS from ALI.But earlier initiation of noninvasive ventilation has no impact on mortality.The patients who tolerate noninvasive ventilation can avoid intubation,especially for young patients.However,the time and indication of shifting from noninvasive ventilation to invasive ventilation should be emphasized.