无创双水平正压通气抢救海水淹溺急性肺损伤的疗效观察

Observation on the therapeutic effect of non-invasive bi-level positive pressure ventilation in emergency medical treatment of acute lung injury induced by seawater drowning

目的 探讨无创双水平正压通气抢救海水淹溺急性肺损伤的疗效.方法 16例海水淹溺急性肺损伤患者,在常规抢救的同时应用无创双水平正压通气呼吸机,选择S/T模式正压通气治疗,观察通气前后动脉血气分析中pH值、动脉血氧分压（PaO2）、动脉血氧饱和度（SaO2）、心率（HR）、呼吸频率（RR）、收缩压（SBP）、舒张压（DBP）和临床症状的变化.结果 通气治疗后,16例患者临床症状明显改善,血气分析中,pH值（7.39±0.02）、PaO2[（95.56±4.10）mm Hg]、SaO2[（95.13±2.06）％]等与治疗前[7.27±0.03、（50.00±4.71）mm Hg、（74.19 ±6.11）％]比较,差异均有统计学意义（P＜0.05）,避免了气管插管机械通气.结论 应用无创双水平正压通气呼吸机通气治疗海水淹溺急性肺损伤,熟练掌握无创双水平正压通气呼吸机的操作,根据病情及时调整呼吸机的参数,确保患者的有效通气,可迅速改善患者症状和低氧血症.无创双水平正压通气不失为抢救海水淹溺急性肺损伤的一种安全、有效的方法.

Objective To explore the therapeutic effect of non-invasive bi-level positive pressure ventilation in emergency treatment of acute lung injury induced by seawater drowning.Methods Sixteen cases of acute lung injury patients induced by seawater drowning were treated with bi-level positive pressure ventilation by using S/T mode,in addition to routine medical treatment.Then,a series of indexes,such as pH,PaO2,SaO2,HR,RR,SBP and DBP were detected,as well as changes in clinical symptoms before and after ventilation.Results After positive pressure ventilation treatment,clinical symptoms of all the patients improved significantly.Blood gas analysis indicated that pH （7.39 ± 0.02）,PaO2 [（95.56 ± 4.10）mm Hg],SaO2 [（95.13 ± 2.06） %] improved,when they were compared with those of before treatment [7.27 ± 0.03、（50.00 ± 4.71） mm Hg,（74.19 ± 6.11） %],with statistical significance （P 〈 0.05）.Mechanical ventilation by tracheal intubation was avoided.Conclusions The application of non invasive bi-level positive pressure ventilation breathing machine for the treatment of acute lung injury induced by seawater drowning,skillful manipulation of the ventilation breathing machine and assurance of effective ventilation of patients by adjusting the breathing parameters of the breathing machine according to the illness status of patients,could effectively improve the symptoms and hypoxemia of patients.The non-invasive bi-level positive pressure ventilation breathing machine is a safe and effective device for emergency treatment of acute lung injury induced by seawater drowning.