机械通气在SARS治疗中的应用

Mechanical Ventilation in Treatment of SARS

为探讨机械通气在SARS病人治疗中的应用,对重症SARS病人经一般面罩、鼻导管吸氧治疗后仍无明显改善者,改用机械通气。根据情况采用无创呼吸机通气或行气管内插管/气管切开造口后进行有创机械通气。结果220名SARS病人重症者131例,进行机械通气者32例,占全组病人的14.55%,占重症病人的24.43%。仅用无创机械通气者24例,占机械通气病例的75%,占重症病例的18.32%。有创机械通气者8例,占机械通气病例的25%,占重症病例的6.11%。其中气管插管6例,占机械通气病例的18.75%,占重症病例的4.58%;气管切开造口3例(其中1例先行气管插管,后又行气管造口),占机械通气病例的9.38%,占重症病例的2.29%。机械通气者中死亡16例,占全组病例的7.27%,占重症病例的12.21%,占机械通气病例的50%。气管插管6例中,死亡5例,占83.33%;改善、痊愈者仅1例,占16.67%。气管造口3例,均死亡。重症病人未进行机械通气者99例,占重症病例的75.57%,其中死亡3例,占3.03%;改善、痊愈者96例,占96.97%。机械通气者中,并发气胸、纵隔气肿或皮下气肿者共7例,占机械通气者的21.88%。提示无创机械通气在重症SARS病人治疗中有积极意义;但有创机械通气应慎用。气管切开造口术对其治疗无特殊积极意义,气管插管的适应证宜严格掌握,插管应在麻醉下实施。

The objective was to study the application of mechanical ventilation(MV)in the treatment of SARS.Methods:We applied mechanical ventilation to the patients who did not improve after oxygen inhalation by mouth or nose.Artificial ventilation was used through noninvasive ventilator or endotracheal tube/tracheostomy.Results:There were131severe patients in220SARS.Mechanical ventilation were applied in32cases,which amounted to14.55%of220SARS and24.43%of severe patients.24cases(18.32%of severe patients)used only noninvasive ventilator,which amounted to75%of the total mechanical ventilation.6cases received tracheal intubation and3cases received tracheostomy(1case received tracheostomy after tracheal intubation).16cases died in mechanical ventilation,which amounted to7.27%of220SARS,and12.21%of severe patients,50%of mechanical ventilation.5cases died in6cases of tracheal intubation.3cases of tracheostomy all died.99cases of severe patients did not use mechanical ventilation,with3cases of them died and96cases of them recovered.Conclusion:Noninvasive ventilation is useful in treatment of SARS.Tracheostomy is of little value.Endotracheal intubation should be performed with general anesthesia.