不同方式机械通气治疗危重支气管哮喘39例

Application of different mechanical ventilations in treatment of critical bronchialasthma

目的:比较常规机械通气、无创-有创-无创序贯性机械通气和有创-无创序贯性机械通气治疗危重支气管哮喘的临床疗效。方法:对常规药物治疗无效的39例危重支气管哮喘患者分别进行不同方式机械通气,分别为A组:常规机械通气组13例;B组:无创-有创-无创序贯性机械通气组13例;C组:有创-无创序贯性机械通气组13例。观察有创机械通气时间、总机械通气时间、呼吸机相关性肺炎(VAP)发生率、再插管率的差异来评价不同机械通气治疗危重支气管哮喘的疗效。结果:A组和B、C组相比,其机械通气时间、总机械通气时间、住院时间、VAP发生率、再插管率明显降低(P<0.05)。B组与C组相比,差异无统计学意义(P>0.05),但B组中有5例应用BiPAP后无需再应用有创通气即恢复自主有效通气,且B组通气后的临床症状明显比C组患者轻。结论:危重支气管哮喘患者采用有创-无创序贯性通气和无创-有创-无创序贯性通气都是治疗危重支气管哮喘行之有效的手段,但无创-有创-无创性序贯通气治疗更能减轻患者的痛苦,并发症最少,同时也能根据患者病情选择合适的通气方式对患者进行继续治疗或抢救。

Objective： To compare the effect of conventional mechanical ventilation,sequential non-invasive following invasive-nonvasive mechanical ventilation and sequential non-invasive following nonvasive mechanical ventilation on critical bronchialasthma.Methods： A total of 39 patients with critical bronchialasthma,to whom the conventional medical treatment was invalid,were divided to three groups radomly.Patients in Group A were treated with conventional mechanical ventilation,Group B with sequential non-invasive following invasive-nonvasive mechanical ventilation,Group C group： with sequential non-invasive following nonvasive mechanical ventilation.The duration of invasive ventilation,total duration of mechanical ventilation,incidence of venti1ator-associated pneumonia（VAP）,and the re-intubation rate were determined.Results： The invasive ventilation time,the total duration of mechanical ventilation,hospitalization time,incidence of VAP,the re-intubation rate in Group B and Group C were significantly decreased compared with Group A（P〈0.05）.There were no significant differences between Group B and Group C（P〉0.05）.Five patients in Group C didn′t need invasive ventilation after application of BiPA,and patients′ clinical symptoms in Group B were obvious relieved compared with Group C.Conclusions： Both sequential non-invasive following invasive-nonvasive mechanical ventilation and sequential non-invasive following nonvasive mechanical ventilation are effective on critical bronchialasthma.But the latter therapy is more effective in relieving pain with fewer side effects.And it is helpful in selecting appropriate ventilation based on patients′ status.