有创-无创序贯机械通气救治蛇咬伤致呼吸衰竭的临床研究

Clinical research on treatment for respiratory failure in snake bite patients using sequential invasive followed by non-invasive mechanical ventilation

目的探讨有创、无创序贯机械通气治疗蛇咬伤致呼吸衰竭的疗效。方法选取22例蛇咬伤并呼吸衰竭的患者予有创后脱机拔除气管插管序贯无创机械通气治疗。19例采用传统机械通气治疗,记录并分析比较两组间患者有创机械通气时间、住呼吸重症监护病房时间、总机械通气时间,总住院时间及呼吸机相关性肺炎(VAP))发生率、再插管率等。结果有创-无创序贯机械通气治疗蛇咬伤并呼吸衰竭疗效显著,有创通气时间、总通气时间及入住呼吸重症监护室(RICU)时间较传统组显著减少(P<0.05),VAP的发生率也明显减少(P<0.05)。拔管后均无需再插管,死亡率两组无差异。结论在患者蛇毒控制,呼吸肌麻痹逐渐改善,咳嗽有力的情况下,停有创,序贯无创治疗具有优越性。

Objective To discuss the clinical therapeutic effect of sequential invasive and non-invasive mechanical ventilation in snake bite patients with respiratory failure. Methods A total of 22 snake bite patients insulting respiratory failure were randomly selected, and then underwent sequential invasive and non-invasive mechanical ventilation. Another 19 patients underwent conventional inyasive mechanical ventilation. Results Sequential invasive and non-invasive mechanical ventilation in snake bite patients insulting respiratory failure brought about more significant therapeutic effect on shortening invasive mechanical ventilation time, respiratory intensive care unit （RICU） stay time and total time length of hospitalization （ P 〈 0.05 ）. The incidence of ventilator associated pneumonia （VAP） in sequential invasive and non-invasive mechanical ventilation was significantly lower than that in conven- tional treatment （ P 〈 0.05 ）. Reintubation was unnecessary in both the two groups. There was no difference in mortality between the two groups. Conclusion After venomous snake bite was controlled and respiratory muscle paralysis was gradually improved, sequential invasive and non-invasive mechanical ventilation had superiority.