高压氧舱内危重症呼吸机支持治疗安全性研究

Study on the safety of ventilator support for critical patients in hyperbaric oxygen chamber

目的探讨高压氧舱内呼吸机应用的安全性和相关并发症的防范。方法2016年7月-2018年12月共有127例重症监护病房患者带呼吸机高压氧治疗,在治疗过程中安排医护人员陪舱,严密观察病情变化,全程监测患者心率、呼吸、血压和氧饱和度变化,舱内根据需要随时吸痰并监测气道峰压变化,防止气胸发生。结果带机高压氧治疗期间发生人机对抗需采用镇痛、镇静13例(10.24%),急性左心衰竭紧急减压出舱4例(3.15%),癫痫发作3例(2.36%),误吸3例(2.36%),呼吸心搏骤停1例(0.79%)。上述患者经过急救治疗,均安全返回病房。结论重症监护病房患者带呼吸机高压氧治疗过程中,由高压氧舱合格的工作人员(高压医学和重症监护医学)陪舱,可及时对患者发生的症状进行治疗,大大降低风险。

Objective To explore the safety of ventilator support in hyperbaric oxygen chamber and the prevention of related complications. Methods From July 2016 to December 2018, there were 127 intensive care unit patients underwent hyperbaric oxygen therapy with ventilator. Medical professionals in hyperbaric medicine or intensive care medicine were arranged to accompany the patients in the treatment process, to observe the patients’ condition changes closely, monitor their heart rate, respiration, blood pressure, and oxygen saturation, and perform sputum suction at any time if needed and monitor the airway peak pressure change to prevent pneumothorax.Results During the process of hyperbaric oxygen therapy, 13 patients(10.24%) were treated with analgesia/sedation for patient-ventilator asynchrony, 4 patients(3.15%) exited the champer emergently for acute left heart failure, 3 patients(2.36%) had epileptic seizures, 3 patients(2.36%) had aspiration, and 1 patient(0.79%) had breath and cardiac arrest. After emergency treatment, all the patients returned to the ward safely. Conclusion During the treatment of hyperbaric oxygen therapy for intensive care unit patients with ventilator, the accompany of qualified professionals in hyperbaric medicine or intensive care medicine in the hyperbaric oxygen chamber can treat the patients’ symptoms timely and reduce the risk greatly.