正压通气危险人群的通气策略

POSITIVE PRESSURE VENTILATION STRATEGIES IN RISK POPULATION

探讨原属机械通气“禁忌证”的特殊人群的正压通气可行性 ,及其正确的通气策略和方法。回顾性分析 110例次 ,包括肺大疱 2 7例次 ,急性心肌梗死 (AMI) 2 0例次 ,休克 43例次 ,咯血 15例次和活动性肺结核 5例次 ,因严重呼吸衰竭行正压通气的效果及并发症发生情况。结果 :机械通气后绝大多数患者的血气明显改善 ,生命延长或随基础病的好转在病情稳定后撤机拔管。在实施恰当的通气策略后 ,机械通气的严重并发症也不多见。结论 :肺大疱、AMI、休克、咯血和肺结核患者 ,只要有强烈的适应证 ,进行正压通气是可行的。重要的是要根据基础病因和患者的具体情况 ,采取正确的通气策略和方法。

To explore the feasibility, proper strategies and methods of positive pressure ventilation in the risk population originally contraindicated for mechanical ventilation, to avoid severe complications and improve its effect. The effects and complications were restrospectively studied in 110 hospitalized patients who were intubated or tracheotomized for ventilation during severe respiratory failure, including pneumo-bullae 27 case-times, acute myocardial infarction (AMI) 20, shock due to various reasons 43, hemoptysis 15, and active pulmonary tuberculosis 5. Results: Blood gases in most patients improved markedly after mechanical ventilation.Life has been prolonged or weaned from the ventilator and tracheal tubes removed when primary diseases improved and remained stable, a few severe complications of mechanical ventilation were found only by applying proper ventilatory strategies. Conclusion: Positive ventilation is practicable for the risk population suffering from pneumo-bullae, AMI, shock, hemoptysis, or pulmonary tuberculosis, when strong indications exist. The important point is to use a proper ventilation strategy and suitable method according to primary diseases and the specific condition of the patient.