无创机械通气治疗甲型H1N1流感危重症的临床观察

CLINICAL OBSERVATION OF TREATMENT OF SERIOUS PATIENTS WITH INFLUENZA A/H1N1 BY NONINVASIVE POSITIVE AIRWAY PRESSURE

目的:探讨无创机械通气对甲型H1N1流感危重症患者的临床疗效及应用价值。方法:收集2009年9月至12月成都市传染病医院收治的11例甲型H1N1流感危重症患者采用无创呼吸机经鼻面罩双水平正压通气治疗资料,监测通气前后患者动脉血气(pH、PaO2、PaCO2、SaO2、PaO2/FiO2)的变化,并观察其临床疗效。结果:所有患者均能较好耐受,治疗后24h各项血气分析指标较治疗前有明显提高(P<0.05),结束治疗时与治疗后24h各项血气分析指标相比也有明显提高(P<0.05),另2例病情危重者改为有创机械通气后均死亡。结论:无创机械通气可以改善甲型H1N1流感危重患者的氧合状况,耐受性和安全性好,是治疗甲型H1N1流感危重症患者合并呼吸衰竭安全有效的治疗手段之一。

Objective：To investigate the therapeutic efficacy of noninvasive positive airway pressure （NPPV） for serious patients with influenza A/H1N1. Methods：The clinical data of 11 influenza A/H1N1 cases with respiratory failure treated by noninvasive ventilator in Infectious Diseases Hospital of Chengdu in Sichuan Province from September to December in 2009 were retrospectively analyzed. The main analytic Contents including im- provement of hypoxemia,complications and prognosis,parameters of arterial blood gas analysis （pH,PaO2,PaCO2, SaO2,PaO2/FiO2）before and after NPPV, and its clinical efficacy.Results：The NPPV was well tolerated by all patients,the parameters of blood gas analysis significantly increased 24 hours after treatment （P〈0.05）, 2 cases were dead with invasive mechanical ventilation.Conclusion：Noninvasive mechanical ventilation improves the patients＇ status of oxygenation, has good tolerability and safety, and it is a safe and valuable method for treatmeut of serious patients with influenza A/H 1N 1.