无创正压通气治疗SARS的临床评价

Evaluation of noninvasive positive pressure ventilation in treatment for patients with severe acute respiratory syndrome

目的 :分析无创正压通气 (NIPPV)对严重急性呼吸综合征 (SARS)患者的氧合作用 ,并初步探讨机械通气时机把握问题。方法 :对 2 5例 SARS合并呼吸功能不全而使用 NIPPV治疗 2 4 h后患者的生理指标和氧合功能进行分析 ,然后再将他们分为生存组与死亡组 ,比较两组患者 NIPPV前后急性生理学与慢性健康状况 (APACHE )评分、改良呼吸指数 (PO2 / Fi O2 ,MRI)的变化。结果 :虽然 NIPPV 2 4 h内多数患者呼吸困难有不同程度缓解、心率 (HR)和呼吸频率 (RR)明显减慢 (P均 <0 .0 5 )、脉搏容积血氧饱和度 (Sp O2 )和 MRI显著升高 (P均 <0 .0 5 ) ,但死亡组患者从发病到 NIPPV治疗的平均时间明显晚于生存组患者 ,且死亡组患者经NIPPV2 4 h后 APACHE 、RR仍显著高于生存组 (P均 <0 .0 5 ) ;Sp O2 、MRI明显低于生存组 (P均 <0 .0 5 )。结论 :对重症 SARS患者而言 ,NIPPV是机械通气的选择方式 ,但它无法替代有创机械通气治疗。治疗 SARS时不能错过 NIPPV或有创机械通气治疗时机 ,且绝不能拘泥于现行的无创或有创通气指征。

Objective: To analyze the effects of noninvasive positive pressure ventilation (NIPPV)on oxygenation of severe acute respiratory syndrome (SARS) patients, and to discuss the timing point for mechanical ventilation. Methods: Twenty-five SARS patients with respiratory dysfunction treated with NIPPV were studied retrospectively in order to evaluate the influences within 24 hours after initiation of ventilatory support on their physiological indices and oxygenation. Patients with SARS were divided into two groups: survivor group(n=13) and non-survivor group(n=12). We compared the acute physiology and chronic health evaluation(APACHEⅡ) score, respiratory rate (RR),saturation of oxygen (SpO 2) and modificative respiratory index (MRI) for the survivors and non-survivors before NIPPV and after NIPPV for twenty-four hours, respectively. Results: Although NIPPV administered via full-face masks might be an effective treatment for rapidly improving vital signs and gas exchange and sense of dyspnea in both groups during the initial 24 hours of ventilatory support, the patients in non-survivor group had higher APACHEⅡ score? respiratory rates and lower SpO 2?MRI than the patients in survivor group(P<0.05) at the same intervals after initiation of support. Conclusion: Noninvasive ventilation should be used as a substitutive tool for endotracheal intubation an alternative treatment for acute respiratory failure related to SARS. Therefore, we should make efforts to avoid missing the time point for NIPPV or intubation, and we should not be restricted to the available indications for NIPPV or IPPV.