无创通气在颈椎损伤并呼吸衰竭救治中的评估  

Evaluation of N-BiPAP in treatment of acute cervical spine injury with respiratory failure

作　　者：王波[1] 张存海[1] 陈飞翔[1] 孙平[1] 

机构地区：[1]浙江省杭州市解放军第117医院,310013

出　　处：《临床肺科杂志》2007年第12期1325-1326,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的评估无创通气在颈椎损伤并发呼吸衰竭救治中的作用。方法19例颈椎损伤致高位截瘫并呼吸衰竭的住院患者,比较无创通气前后血气变化,及治疗结果。结果病人应用无创通气后1h和24h的血气均明显改善,但19例患者中有12例在第2～5天符合治疗标准而行气管插管或气管切开人工支持通气,另2例分别在第9、10天行气管切开。只有2例患者成功脱离无创通气,3例因脓毒症、MODF死亡。无创通气并发症包括鼻部压伤和胃胀气。结论无创通气在颈椎损伤并呼吸衰竭救治中并不是最佳选择,及早实施气管插管或气管切开术可避免一些严重并发症的发生。Objective To evaluate the safety and efficacy of N-BiPAP in patients with acute respiratory failure due to acute cervical trauma （ACT）. Methods Prospective observational study was conducted. Nineteen patients with acute low cervical spine injury were studied. N-BiPAP was applied via a tight-fitting full or total-face mask with comparing the changes in blood gasses and effectiveness of N- BiPAP. Results The acute response of oxygenation to N-BiPAP differed significantly ： it had high response at first 1 h and 24 h after application of N-BiPAP, but failed afterward due to sputum and respiratory infection. Twelve out of 19 patients met predefined criteria and required intubation or tracheotomy within 2 to 5 days after N-BiPAP and two patients also intubated at 9 or 10 days after N-BiPAP. Only 2 patients were deemed uncessary of using intubation and were discharged from the ICU. Three of the patients died due to refractory septic shock or MODF. Complications related to N-BiPAP consisted of nose bridge injury （2 patients） and gastric distention （3 patients）. Conelusion N-BiPAP administration might not be the best therapy in patients with acute cervical trauma. Delaying intubation or tracheotomy may be associated with significant adverse effects.

关 键 词：颈椎损伤 呼吸衰竭 气管切开术 

分 类 号：R683[医药卫生—骨科学] R563.8[医药卫生—外科学]