无创机械通气治疗急性肺损伤29例效果观察

Efficacy Observation of Noninvasive Positive Pressure Ventilation in Treatment of 29 Patients with Acute Lung Injury

目的观察无创机械通气(NPPV)治疗急性肺损伤(acute lung injury,ALI)的可行性和安全性。方法 2009年1月—2012年10月我科NPPV治疗的ALI 29例,均选择S/T模式,根据病情适时调整呼吸机参数,并详细记录NPPV前,NPPV后1、12、24 h及脱机后呼吸频率、氧分压(PaO2)和氧合指数。结果本组25例NPPV治疗后,症状逐渐好转,生命体征渐平稳,NPPV后各时间点及脱机后呼吸频率、PaO2和氧合指数较治疗前明显改善,除NPPV后1 h呼吸频率外,余差异均具有统计学意义(P<0.05)。此25例平均上机时间8.9 d,无呼吸机相关性肺炎发生,均痊愈出院。4例NPPV治疗无效,改为有创机械通气,其中3例痊愈,1例重症肺炎未能有效控制病情,最终诱发多脏器功能障碍综合征死亡。结论 NPPV治疗ALI安全、有效,且有助于改善患者预后。

Objective To investigate the feasibility and safety of noninvasive positive pressure ventilation （NPPV） in treat ment of acute lung injury （ALI）. Methods The 29 patients with ALI during January 2009 and October 2012 in our department were treated by NPPV with S/T model, and the parameters of breathing apparatus were adjusted according to pathogenetie condi tions. The change of respiratory rates, pappenheimer 02 （PaO2） and oxygenation indexes before NPPV, 1 h, 12 h and 24 h after NPP~ and after offline were recorded. Results After NPP~ treatment, the 25 patients＇symptoms improved with stable vital signs. The respiratory rates, PaO2 and oxygenation indexes at each time point after NPPV and after offline were significantly improved, ex cept 1 h after NPPV of respiratory rate （P 〈0. 05）. The average time of using breathing apparatus was 8.9 days without ventilator associated pneumonia. All the patients were cured and discharged. The other 4 patients were given invasive positive pressure venti lation treatment after NPPV treatment failed, 3 patients recovered, and one with severe pneumonia died of acute respiratory distress syndrome caused by incontrollable pathogenetie condition. Conclusion The method of NPPV in treatment of ALI is safe and effec tive with better prognosis.