不同通气模式治疗危重型哮喘患者临床疗效对比

Comparison analysis of different support ventilations in treatment of severe asthma

目的探讨分析2种不同通气模式治疗危重型哮喘患者的安全性和临床疗效,为临床疾病诊治提供理论依据。方法 2012年2月-2015年2月我院收治的重症哮喘患者共94例,按入院时间先后随机分为A组、B组,每组各47例。所有患者均行常规哮喘及对症治疗,其中A组行传统机械通气治疗,B组行适应性支持通气(ASV)治疗,观察比较2组患者机械通气前后动脉血氧浓度、动脉二氧化碳浓度及p H值等血气分析指标、机械通气时间、住院时间、胸部气压损伤及疾病疗效等情况。结果 2组患者初始动脉血气分析指标比较差异无显著性(P>0.05)。机械通气后PCO2、PO2及p H值指标均较通气前有明显改善(P<0.05),但2组比较差异无统计学意义(P>0.05)。传统机械通气治疗通气时间及住院时间均明显长于适应性通气治疗组患者(P<0.05)。A组患者治疗过程出现5例胸部气压伤(2例气胸和3例皮下气肿),B组患者仅出现1例皮下气肿,2组相比,差异有统计学意义(P<0.05)。结论适应性支持通气治疗危重型哮喘能显著改善患者动脉血气情况,减少治疗并发症,缩短机械通气及住院时间,是一种安全而有效地机械通气方式。

Objective To investigate two different support ventilation modes for treating severe asthma so as to provide certain theoretical basis for clinical disease diagnosis and treatment. Methods 94 severe asthma patients admitted to our hos- pital between February 2012 and February 2015 were divided into two groups ,each with 47 cases. Group A were treated by tra- ditional support ventilation, and group B by adaptive support ventilation. PO2, PCO2, PH, average hospitalization, average venti- lation time and thorax barotrauma of the two groups were observed. Results There were no obvious differences between the two groups in terms of the initial statistical analysis （ P 〉 0.05）. After mechanical ventilation, PCO2 , PO2 and PH indicators were obviously improved（ P 〈0.05 ） ,but with no statistical difference between each other（ P 〉0.05 ）. Time of traditional me- chanicai ventilation and hospital stay was significantly longer than that of adaptive ventilation in the treatment group （ P 〈 0. 05 ）. 5 cases of chest barotrauma （ 2 cases of pneumothorax and 3 cases of subcutaneous emphysema ） occurred in group A compared with only 1 case of subcutaneous emphysema in group B. The difference was statistically significant （ P 〈 0.05）. Conclusion Adaptive support ventilation in treatment of severe asthma can significantly improve arterial blood gas, reduce complications, and shorten the time of mechanical ventilation and hospitalization. Mechanical ventilation is a safe and effective way.