危重哮喘(濒死状态)4例诊治分析

目的分析危重哮喘的临床特点及抢救经过,提高危重哮喘的抢救成功率。方法收集我院急诊科收治的危重哮喘需要心肺复苏的患者,对其一般情况、临床特点、治疗及预后进行分析。结果 (1)共有4例患者纳入研究,年龄范围在19岁~52岁,男3例,女1例,明确诊断哮喘均在10年以上,平素吸入激素及支气管扩张剂,且均在来诊前有哮喘发作,并呈进行性加重;(2)4例患者血气分析均有呼吸性酸中毒及低氧血症,静脉输注氢化考的松及氨茶碱药物治疗。3例患者发生呼吸心跳停止,予以心肺复苏,1例患者仅发生呼吸停止,予以呼吸支持。其中2例死亡(一例为送医延迟;一例发生呼吸停止,心跳未停止),2例存活(两例均发生呼吸心跳停止,一例一周后出院,遗留轻微反应迟钝,一例因合并肺栓塞昏迷3月余,遗留视力损伤)。结论危重哮喘定义范围较广,对于发生呼吸心跳停止患者,应该单独分级为危重哮喘濒死状态。危重哮喘不及时控制发作,会快速进展,抢救难度加大,死亡率高。危重哮喘濒死状态者,治疗应该综合治疗,全身用药,兼顾脏器功能,解除气道痉挛为重。

Objective To analyze the clinical characteristics and rescue process of critical asthma and improve the success rate of rescue.Methods The general situation,clinical characteristics,treatment and prognosis of patients with critical asthma requiring cardiopulmonary resuscitation from January 01,2016 to June 30,2018 were analyzed.Results(1)A total of 4 patients were included in the study,aged 19~52 years,3 males and 1 females.All the patients were diagnosed as asthma for more than 10 years.Both inhaled corticosteroids and bronchodilators had asthma attack and progressive exacerbation before coming to the clinic.(2)4 patients had respiratory acidosis and hypoxemia by blood gas analysis.Intravenous hydrocortisone and aminophylline were used for the treatment.Cardiopulmonary resuscitation was performed in 3 patients with respiratory and cardiac arrest,and respiratory support was provided in 1 patient with respiratory arrest.Two of them died(one was delayed medical treatment,one had respiratory arrest and no cardiac arrest),and two survived(both had respiratory arrest,one was discharged a week later,with mild delayed response,and one was comatose with pulmonary embolism for more than 3 months,with visual impairment).Conclusion Critical asthma has a wide range of definitions.For patients with respiratory and cardiac arrest,it should be separately classified critical asthma near-death state.critical asthma does not control seizures in time,it will progress rapidly,rescue difficulties and high mortality.In critically ill asthmatic patients with dying state,comprehensive treatment,systemic medication,organ function and relief of airway spasm should be emphasized.