先天性脊柱畸形伴呼吸衰竭的临床诊治分析——附3例病例报告

Diagnosis and treatment of congenital spinal deformity with respiratory failure: a report of 3 cases

目的总结3例先天性脊柱畸形伴呼吸衰竭患者的诊治情况,提高该类患者的临床诊治水平。方法回顾性分析3例先天性脊柱畸形患者,在肺部感染后出现严重的Ⅱ型呼吸衰竭,均给予积极的气管插管、机械通气,并完善气管镜检查,加强抗感染、痰液引流、营养支持等综合治疗,之后给予无创呼吸机辅助通气序贯治疗。结果 3例患者经有创机械通气、无创机械通气序贯治疗,以及抗感染、化痰等综合治疗后,血气分析提示二氧化碳分压明显下降,二氧化碳潴留减轻,呼吸困难等症状明显缓解,均正常出院。结论积极的有创机械通气和无创机械通气序贯治疗,有助于尽快纠正先天性脊柱畸形患者在肺部感染时出现严重的Ⅱ型呼吸衰竭。

Objective To improve the diagnosis and treatment level of congenital spinal deformity with respiratory failure patients by summarize 3 cases. Methods Retrospective analysis of 3 cases of congenital spinal deformity patients with type II respiratory failure induced by lung infection.They were treated by tracheal intubation,early positive mechanical ventilation,bronchoscopy,antibiotic therapy,aspiration of sputum,nutritional support,and sequential noninvasive ventilation. Results After aggressive invasive mechanical ventilation,sequential non-invasive mechanical ventilation and other comprehensive treatments,blood gas analysis of 3 patients showed that carbon dioxide partial pressure decreased obviously,carbon dioxide retention reduced significantly,and dyspnea symptom was relieved. Three patients discharged from hospital safely. Conclusion Positive invasive mechanical ventilation and sequential noninvasive mechanical ventilation are helpful to correct the severe type II respiratory failure induced by lung infection in patients with congenital spinal deformity.