呼吸机治疗时人机对抗的原因及其防治策略  

Discussion on Remedial Strategy in Patients with Intermittent Positive Pressure Ventilation Resistant to Mechanical Ventilation

作　　者：王凯[1] 严振球[1] 袁延才[1] 袁钰鑫[1] 

机构地区：[1]解放军第169医院心胸外科,湖南衡阳421002

出　　处：《临床军医杂志》2007年第3期422-423,共2页Clinical Journal of Medical Officers

摘　　要：目的探讨呼吸机治疗患者发生人机对抗的病因及处理策略。方法对29例人机对抗患者进行回顾性分析。结果92例机械通气患者中发生人机对抗29例(31.5%),其中死亡2例(6.9%)。其原因包括:气道阻塞10例,支气管痉挛3例,潮气量不足2例,持续高热4例,急性肺水肿5例,单肺通气2例,呼吸机漏气2例,气胸1例。结论人机对抗的发生均有其诱发因素。气道阻塞、潮气量不足、急性肺水肿等是主要原因。加强气道管理、设置合适的通气量、解除气道痉挛、祛除诱因等,可避免和减少人机对抗的发生。Objective To discuss the masons and the remedial strategy of the patients with intermittent positive pressure ventilation （IPPV） resistant to mechanical ventilation. Methods We analyzed 29 patients with IPPV resistant to mechanical ventilation retrospectively. Results There were 29 cases （31.5%） resistant to mechanical ventilation among 92 cases with IPPV, and two （6.9%） ot the 29 eases died. The causes of resistance were multiple, including airway obstruction in ten, bronchial spasm in three, insufficient tidal volume in two, persistent high fever in four, acute pulmonary edema in five, single lung ventilation in two, leakage ot ventilator in two, and pneumothorax in one ease （s）. Conclusion The causes of resistance to mechanical ventilation are mainly airway obstruction, bronchial spasm, insuffieent tidal volume, etc. The ratio of the patients with IPPV resistant to mechanical ventilation can be reduced through enhancing airway management, setting up adequate respiratory mechanical parameter and relieving bronchial spasm.

关 键 词：呼吸机治疗 呼吸衰竭 人机对抗 原因 

分 类 号：R563.8[医药卫生—呼吸系统]