山莨菪碱和无创面罩正压通气治疗急性呼吸窘迫综合征的临床观察  

Treatment of Acute Respiratory Distress Syndrome with Anisodamine and Noninvasive Positive Pressure Ventilation

作　　者：颜春松[1] 罗俊明[1] 况九龙[1] 饶纬华[1] 

机构地区：[1]南昌大学第二附属医院呼吸内科,南昌330006

出　　处：《江西医学院学报》2006年第5期43-47,共5页Acta Academiae Medicinae Jiangxi

基　　金：江西省卫生厅课题(2002年度)

摘　　要：目的比较山莨菪碱联合无创正压面罩通气(654-2+NIPPV)和传统机械通气(CMV)治疗急性呼吸窘迫综合征(ARDS)的临床效果,评估山莨菪碱联合无创正压通气在ARDS治疗中的作用。方法将各种原因所致ARDS患者42例随机分为654-2+NIPPV组(21例)和CMV组(21例),在给予病因治疗同时分别实施654-2+NIPPV和CMV。观察分析两组患者在治疗过程中动脉血气变化、并发症的发生率及治疗效果。结果654-2+NIPPV组有8例(38.1%)治疗失败转为气管插管实行CMV,其中6例(28.6%)死亡。CMV组死亡7例(33.3%),两组病死率无显著差异(P>0.05)。两组治疗有效的患者在分别接受654-2+NIPPV和CMV治疗后1h和6 h动脉血气有相似的显著改善。654-2+NIPPV组患者机械通气时间和住院时间短于CMV组(P<0.05)。654-2+NIPPV组的并发症发生率低于CMV组(P<0.05)。结论在经过选择的ARDS患者中,应用654-2+NIPPV治疗的临床效果与CMV相似。实施654-2+NIPPV可缩短机械通气和住院时间,减少并发症。654-2+NIPPV可作为经过选择的ARDS患者首选的通气支持治疗手段。Objective To compare the treatment efficacy of Anisodamine （654-2） combined with noninvasive positive pressure ventilation （654-2 ＋NIPPV） with that of conventional mechanical ventilation（CMV） in patients with acute respiratory distress syndrome（ARDS） and evaluate the effect of 654-2 ＋ NIPPV on the treatment of ARDS. Methods Forty-two patients with ARDS caused by various disorders were randomly divided into 654-2 ＋ NIPPV group（21 cases） and CMV group（21cases）. Patients in two groups were treated by 654-2＋NIPPV through a facemask or CMV with endotracheal intubation respectively when disorders causing ARDS managed by medical therapy. Arterial blood gases were analyzed, and the rate of complication and outcome were observed. Results In 654-2 ＋NIPPV group, 8 patients were transformed into CMV for worsening condition and arterial blood gases. Mortality rate in 654-2 ＋ NIPPV group （28.6 %） was similar to CMV group（33.3%）（P〉0. 05）. After 1 hour and 6 hours of ventilation ,artery blood gas of patients of both two groups improved significantly and similarly. Duration of mechanical ventilation and hospital stay for patients receiving 654-2 ＋ NIPPV were significantly shorter than those in patients receiving CMV （P〈0.05）. The complication rate in 654-2＋NIP- PV group was markedly lower than that in CMV group（〈0.05）. Conclusion Clinical efficacy of 654-2＋NIPPV was similar to CMV in selected patients with ARDS. Use of 654-2＋NIPPV in patients with ARDS might reduce duration of mechanical ventilation and hospital stay, and decrease rate of complication. 654-2＋NIPPV might be the ventilatory support therapy of the first choice for the selected patients with ARDS.

关 键 词：急性呼吸窘迫综合征 山莨菪碱 无创正压通气 传统机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]