有创通气在重症严重急性呼吸综合征患者中的应用  

Invasive Ventilation in Critical Patients with Severe Acute Respiratory Syndrome (SARS)

作　　者：周立新[1] 誉铁鸥[1] 方滨[1] 李轶男[1] 温伟标[1] 邹毅成[1] 马明远[1] 毛克江[1] 

机构地区：[1]广东省佛山市第一人民医院ICU,佛山528000

出　　处：《中国循证医学杂志》2004年第8期573-577,共5页Chinese Journal of Evidence-based Medicine

摘　　要：目的　探讨有创机械通气在重症严重急性呼吸综合征 (SARS)中的应用效果。方法　对 2 0 0 2年 11月至 2 0 0 3年 4月佛山市第一人民医院ICU收治的 6例重症SARS患者有创机械通气的疗效和隔离防护的效果进行回顾性分析。结果　 6例重症SARS患者均成功撤离呼吸机 ,痊愈出院 ,无一例死亡 ;机械通气撤离时低氧血症和氧合指数较实施前均明显改善 (P <0 0 0 1) ,气道峰压 (P =0 0 0 2 )和气道均压 (P =0 0 0 4 )显著降低 ,所需呼吸末正压水平亦明显减少 (P <0 0 0 1) ;发生呼吸机相关性肺炎 5例 ;与SIMV通气相比较 ,采用PRVC通气时所用镇静剂用量较小 ,通气时间较短 ;无医务人员、患者和患者家属发生SARS院内感染。结论　对重症SARS患者实施肺保护性通气策略和有效的隔离防护 ,能降低死亡率 ,减少机械通气时间 。Objective To study the efficacy of invasive ventilation in critical severe acute respiratory syndrome(SARS). Methods Retrospective analysis was applied to study the efficacy of invasive ventilation and the effect of isolating and protecting measures in 6 critical SARS patients and the effect of isolation measures in ICU from November 2002 to April 2003. Results Six SARS patients were successfully weaned from mechanical ventilation and left hospital. Hypoxemia and oxygenation index(PaO 2/FiO 2)improved significantly after ventilation (P<0.01), peak inspiratory airway pressure (P=0.002), mean airway pressure (P=0.004), and the level of positive expiration end pressure decreased significantly (P<0.001). Ventilator-associated pneumonia occurred in 5 patients. Sedatives were used less and the duration of ventilation was shorter when using PRVC compared with SIMV. There was no SARS nosocomial infection among medical staff, other patients and their families. Conclusions Application of invasive ventilation and effective isolation measures could reduce the death rate, shorten the duration of ventilation, and also decrease SARS nosocomial infection.

关 键 词：重症严重急性呼吸综合征 机械通气 肺保护 隔离防护 

分 类 号：R511.9[医药卫生—内科学]