无创正压通气治疗急性呼吸窘迫综合征的前瞻性队列研究  

Non-invasive positive pressure ventilation in patients with acute respiratory distress syndrome： a prospective cohort study

作　　者：丁琳[1] 詹庆元[1] 罗祖金[1] 李洁[1] 夏金根[1] 姚秀丽[1] 王辰[1] 

机构地区：[1]首都医科大学附属北京朝阳医院,北京呼吸疾病研究所,北京100020

出　　处：《中国危重病急救医学》2009年第10期613-616,共4页Chinese Critical Care Medicine

基　　金：基金项目：北京市科技新星计划（2005803）;首都特色临床医学技术发展研究项目（Y0905001040291）

摘　　要：目的观察和评价无创正压通气（NPPV）对急性呼吸窘迫综合征（ARDs）的疗效和安全性。方法采用前瞻性队列研究，分析2004年1月-2007年12月北京朝阳医院呼吸重症监护病房（RICU）使用NPPV治疗ARDS患者的临床资料。结果①31例患者纳入本研究，其中男23例，女8例；年龄20～76岁，平均（49±17）岁；NPPV前急性生理学与慢性健康状况评分系统Ⅱ（APAcHE1）评分（14±8）分，氧合指数（PaO2／FiO2）（123±32）mmHg（1mmHg=0．133kPa）。②NPPV成功率为74．2％（23／31），非肺部感染所致ARDS的成功率显著高于肺部感染所致ARDS（100％比60％，P=0．017）。（3）与NPPV前相比，成功组NPPV治疗后2h及24h的心率（HR）、呼吸频率（RR）及PaO2／FiO2均有显著改善（P均〈0．01），而失败组上述指标不但无显著改善，尚伴有动脉血二氧化碳分压（PaCO2）逐渐升高（P〈O．05）。患者均无NPPV相关的严重并发症。结论对于无NPPV禁忌的ARDS患者，NPPV可作为一线呼吸支持手段；但对于在短期应用NPPV后生命体征及动脉血气无显著改善者，尤其是肺部感染诱发ARDS时应及早改为有创通气。Objective To investigate the efficiency of the application of non-invasive positive pressure ventilation （NPPV） as a first-line intervention in patients with acute respiratory distress syndrome （ARDS）. Methods A prospective cohort study was designed to analyze the clinical data of patients with ARDS in respiratory intensive care unit （RICU） of Beijing Chaoyang Hospital admitted between January 2004 and December 2007. Results （1）31 patients, age （49 ±17） years, with acute physiology and chronic health evaluation I （APACHE I ） score of 14±8 and oxygenation index （PaO2/FiO2） of （123±32） mm Hg （1 mm Hg=0. 133 kPa）, were enrolled in the study. There were 23 males and 8 females. （2）The successful rate of NPPV was 74.2~ （23/31） and it was significantly higher in patients without pulmonary infection than that in patients with pulmonary infection （100% vs. 60%, P=0. 017）. （3）In the successful group, heart rate （HR）, respiratory rate （RR） and PaO2/FiO2 were improved significantly at the time of 2 hours and 24 hours of NPPV compared with NPPV before （all P〈0. 01）, while there was no significant improvement observed in the failure group. Furthermore, an increase in arterial partial pressure of carbon dioxide （PaCO2） was observed in the latter （P〈0.05）. No serious complications were seen in association with NPPV in all recruited patients. Conclusion NPPV may be the first-line intervention for a selected group of ARDS patients, while invasive ventilation should be considered for those patients with high risk of NPPV failure as indicated by worsening of vital signs and arterial blood gas analysis after a short time of using NPPV, and also in cases where pulmonary infection is the underlying disease of ARDS.

关 键 词：无创正压通气 急性呼吸窘迫综合征 前瞻性研究 

分 类 号：R686[医药卫生—骨科学]