允许性高碳酸血症通气治疗急性呼吸衰竭的临床观察

Clinical observation of permissive hypercapnia ventilation treatment for acute respiratory failure

目的 观察允许性高碳酸血症通气治疗急性呼吸衰竭的临床疗效。方法 6 2例急性呼吸衰竭病人行允许性高碳酸血症通气 (PHV) ,其参数设定为潮气量 (VT) 5～ 8ml/kg、气道峰压 <3 43kPa、呼吸频率 (RR) 14～ 18次 /分、吸入氧浓度 (FIO2 )由 1 0逐渐降至 0 4、吸 /呼比 ( 1∶E)为 1∶1 5～ 2 0 ,同时监测PHV前后HR、ECG、MAP、CVP、SpO2 、动脉血气及VT、分钟通气量 (MV)和气道压力变化。根据显效、有效和无效三个标准判定临床治疗效果。结果 36例显效 ,14例有效 ,12例无效。抢救成功率为 80 6 5 % ,死亡率为 19 35 %。在PHV前后 pH、PaCO2 及PaO2 有显著性差异(P <0 0 5 ) ,通气期间无 1例发生气压伤和相关性肺炎等并发症。结论 允许性高碳酸血症通气治疗急性呼吸衰竭 ,疗效确切 。

Objective To Observe the clinical effects of permissive hypercapnia ventilation(PHV) treating acute respiratory failure(ARF).Methods 62 patients suffering from ARF were treated by PHV.Ventilation parameters were V T 5 8ml/kg,PI P< 3 43kPa,RR14 18breaths/min.F IO 2 1 0 reduced to 0 4,I/E 1∶1 5 2 0 and HR,ECG,MAP,CVP,SpO 2,PaO 2,PaCO 2,V T and airway pressure were determined before and after PHV.Clinical treatment effects were judged.Results It was obviously effective in 36 patients,effective 14 patients and ineffective 12 patients.The successful rate was 80 65% and mortality 19 35%.pH,PaO 2 and PaCO 2 were not changed significantly after PHV compared with those before.No complications of barotrauma or rrelated pneumonia occured.Conclusion PHV can be used to treat effectively ARF and barotrauma is prevented.