无创正压通气救治重症哮喘的临床评价

Clinical Evaluation of Noninvasive Positive Pressure Ventilation in the Treatment of Severe Asthma

目的 评价无创正压通气 (NPPV)在救治重症哮喘并呼吸衰竭中的价值。方法 14例重症哮喘并呼吸衰竭患者在给予药物治疗同时实施 NPPV。结果 实施 NPPV后 1～ 6小时 ,该组患者的动脉血氧分压 (Pa O2 )、二氧化碳分压 (Pa CO2 )、p H以及呼吸频率 (RR)和心率 (HR)较 NPPV治疗前明显改善 (P<0 .0 5 ) ,随着 PSV的增高和潮气量 (VT)的增大 ,气道吸气峰压 (PIP)反而降低。 2例患者因病情加重而改为气管插管有创通气。最终 12例患者应用 NPPV救治成功。结论 NPPV用于重症哮喘并呼吸衰竭的治疗是安全有效和可行的。但对

Objective To evaluated clinical value of noninvasive positive pressure ventilation (NPPV) in severe asthma patients with respiratory failure.Methods Fourteen patients with severe asthma and respiratory failure were treated by NPPV in addition to medical therapy. NPPV was delivered to the patient by a face mask connected to a ventilator set in pressure support ventilation (PSV) and continuous positive airway pressure (CPAP). Arterial blood gases and vital signs were observed and analyzed. Results There were significant improvement of PaO2, PaCO2, pH and respiratory rate, heart rate in the one and six hours after NPPV therapy, compared with those before NPPV (P<0.05). The artery blood gases and vital sign continued improvement to 24 hours after NPPV. While PSV and tidal volume (V T) increased, airway peak inspiratory pressure (PIP) decreased. Two patients were transformed into endotracheal intubation with invasive positive pressure ventilation for worsening condition. Twelve patients were successfully treated with the NPPV therapy.Conclusion NPPV is effective and safe for the patients with severe asthma and respiratory failure and for those whose conditions won’t improve with medical management. However, NPPV should be transformed into endotracheal intubation and invasive positive pressure ventilation immediately when the clinical condition deteriorates in patients with severe asthma.