对中心性气道狭窄引起的重度呼吸困难进行无创通气治疗初探

Pre-test of non-invasive ventilation in the treatment of serious dyspnea patients caused by main airway stenosis

目的初步探讨高频喷射和双相气道正压通气（BiPAP）两种无创通气方法治疗中心性气道狭窄引起重度呼吸困难的疗效以及两种模式的适用范围。方法采用回顾性分析的方法，将2006年1月至2009年1月收治的中心性气道狭窄引起重度呼吸困难的患者，根据采用高频喷射或BiPAP无创通气方法分成H组和B组，对比两种通气模式缓解呼吸困难及纠正缺氧的有效率。结果H组7例，B组9例。对减轻呼吸困难的疗效评价，H组有效率为14．29％（1／7），仅接受高频喷射呼吸机治疗者4例，有效率为25．00％（1／4），接受高频喷射呼吸机治疗无效，随后应用BiPAP呼吸机治疗有效者2例，接受BiPAP呼吸机治疗好转并撤机，再发呼吸困难后采用高频喷射呼吸机治疗无效者1例。B组中仅接受BiPAP呼吸机治疗者6例，有效率为83．33％（5／6），结合上述与高频喷射呼吸机治疗序贯应用的病例，共9例，有效8例，无效1例，有效率为88．89％，两组比较差异有统计学意义（P=0．006）。在纠正低氧血症疗效方面，H组有效率为100．00％（7／7）；B组有效率为88．89％（8／9），两组比较差异无统计学意义（P=0．563）。结论高频喷射呼吸机对纠正缺氧有效，但对于缓解呼吸困难症状，使患者自觉症状减轻方面效果差，较适合在术前和术中临时进行生命支持；BiPAP呼吸机缓解患者呼吸困难症状的治疗效果可能优于高频喷射呼吸机，可试用于临时缓解症状、术前准备及恶性肿瘤的姑息治疗。

Objective To evaluate the effect of high-frequency jec ventilation and bilevel positive airway pressure （BiPAP） ventilation in the severe dyspnea caused by central airway stenosis and explore the deferent application of two ventilation models. Methods A retrospective analysis was designed to collect the serious dyspnea patients caused by central airway stenosis from January 2006 to January 2009. The patients were divided into group H and group B according to the different ventilation models, and the effect of relieving dyspnea and ameliorating hypoxemia was compared. Results Seven cases were in group H, and 9 cases were in group B. The therapeutic effect of relieving dyspnea was 14.29 %（ 1/7 ） in group H. There were only 4 cases accepting high-frequency jec ventilation and the effect of relieving dyspnea was 25.00% （1/4）. Two cases failed in high-frequency jec ventilation treatment and succeeded in BiPAP treatment thereafter, and 1 case failed in BiPAP treatment initially but was treated effectively by high-frequency jec ventilation after dyspnea relapsed. In group B, there were only 6 cases accepting BiPAP ventilation and the effect of relieving dyspnea was 83.33% （5/6）, and after adding the cases who accepting the sequential therapy of high-frequency jee ventilation and BiPAP ventilation the effect rate was 88.89% （8/9）. The difference had statistical significance（P = 0.006）. In ameliorating hypoxemia, the effect rate of group H was 100.00% （7/7）, of group B was 88.89%（8/9）, and the difference had no statistical significance （P = 0.563）. Conclusions The high-frequency je ventilation is effective to relieve hypoxemia but is short of relieving dyspnea and subjective symptom, and it is suit for life support pre-operative and intraoperative. The BiPAP ventilation is effective to relieve dyspnea and subjective symptom and hypoxemia, so the treatment effect is better than high-frequency jee ventilation, and it is suit in relieving symptom temporarily, pre-operative preparation and malignant tumor palliative treatment.