有创机械通气治疗急性重型脑干出血合并呼吸衰竭临床分析

Clinical analysis of invasive mechanical ventilation in acute severe brainstem hemorrhage with respiratory failure

目的探讨有创机械通气治疗急性重型脑干出血合并呼吸衰竭的临床疗效,提高急性重型脑干出血的救治成功率。方法分析62例急性重型脑干出血合并呼吸衰竭患者的临床资料,积极实施气管插管或气管切开,行有创机械通气,给予晶体与胶体脱水剂联用、应用脑保护剂、促醒、防治并发症、对症支持治疗及完善的护理与康复训练。观察有创机械通气治疗前、后血气分析指标的变化及对患者预后的影响。结果 62例患者应用有创机械通气前、后均行血气分析,治疗后pH、PaO2、PaCO2、SaO2、BE分别与治疗前比较,差异均具有统计学意义(P<0.05)。其中好转出院15例,植物状态10例,经积极救治病情稳定后因各种原因放弃治疗出院12例,死亡25例,救治成功率为59.7%。结论对于急性重型脑干出血合并呼吸衰竭患者,积极行有创机械通气治疗,同时配合药物治疗,可提高治疗的成功率,收效显著。

Objective To evaluate the effect of invasive mechanical ventilation in patients with acute severe brainstem hemorrhage and respiratory failure. Methods 62 cases of patients suffering from acute severe brainstem hemorrhage accompanied by respiratory failure were included in this analysis. All patients received tracheal intubation or tracheotomy followed by invasive mechanical ventilation. Besides, some other basic treatment such as crystalloid and colloidal solution, dehydrant, cerebral protective drugs, promoting revival, supportive treatment, nursing and rehabilitation training and so forth. The results of air blood gas （ABG） before and after treatment were analyzed to study the effect of invasive mechanical ventilation. Results The state of ABG, include pH, PaO2 , PaCO2, SaO2 and BE, improved after the treatment, and the difference was statistically significant （P 〈 0.05 ）. The success rate of this treatment was 59.7% ： 15 patients discharged with improved condition, l0 patients maintained vegetative state, 12 got stable after treatment but discharged voluntarily for kinds of reasons and 25 died. Conclusion Invasive mechanical ventilation combined with medication can improve the outcome of acute severe brainstem hemorrhage with respiratory failure.