序贯性机械通气在重度有机磷农药中毒并发呼吸衰竭中的应用

Research on Application of Sequential Mechanical Ventilation in Patients with Acute Severe Organophos phate Poisoning Accompanied by Respiratory Failure

目的:观察序贯性机械通气在抢救急性重度有机磷农药中毒并发呼吸衰竭的疗效。方法:重度有机磷农药中毒并发呼吸衰竭患者60例,随机分为常规机械通气治疗30例(常规组)和序贯机械通气治疗30例(序贯组),常规组按常规进行有创机械通气,以同步间歇指令通气(SIMV)+压力支持通气(PSV)方式撤机。序贯组先进行有创机械通气,当患者的自主呼吸能触发呼吸机即撤机拔管,进行无创双水平正压通气,以后渐减压力水平直至脱离呼吸机。结果:序贯组有创机械通气时间、总机械通气时间、总住院时间、呼吸机相关性肺炎的发病率、撤机失败率、死亡率与常规组比较,差异均有统计学意义(P<0.05)。结论:序贯性机械通气疗法是治疗重度有机磷农药中毒并发呼吸衰竭的有效手段,能明显缩短有创通气时间,缩短住院时间,降低呼吸机相关性肺炎的发生率和病死率。

Objective： To observe the therapeutic effect of sequential mechanical ventilation in patients with acute severe organophosphate poisoning （ASOP） with respiratory failure （RF）. Methods： Sixty patients with ASOP with RF were randomly divided into routine mechanical ventilation group（30 cases） and invasive and non- invasive sequential ventilation group（30 cases）. The 30 cases in routine mechanical ventilation group were continuous- ly received invasive mechanical ventilation and the 30 cases in sequential ventilation group were conducted by extubation when patients had enough strength to trigger ventilator and followed by non-invasive ventilation via face mask. Results： The difference in invasive ventilation time, the total duration of mechanical ventilation,the length of hospitalization, the incidence of ventilator-associated pneumonia,weaning failure and mortality between the two group had statistical significance（P〈0.05）. Conclusion： Sequential mechanical ventilation is an effective treatment for patients with ASOP accompanied by RF. It can shorten the time of invasive ventilation, the length of hospitalization and reduce the incidence of ventilator-associated pneumonia,and mortality.