中枢性呼吸衰竭患者早期机械通气治疗与延迟治疗的研究  

Significance of early mechanical ventilation in patients of acute cerebral stroke complicated with central respiratory failure： clinical observation of 28 cases

作　　者：刘永华[1] 胡叶[1] 张芝晶[1] 

机构地区：[1]大连市中心医院急诊ICU,辽宁116033

出　　处：《中国急救复苏与灾害医学杂志》2009年第11期847-850,共4页China Journal of Emergency Resuscitation and Disaster Medicine

摘　　要：目的比较早期机械通气与延迟机械通气对急性脑卒中伴中枢性呼吸衰竭患者的救治效果。方法将312例需机械通气的急性脑卒中合并中枢性呼吸衰竭患者，根据开始机械通气的时间先后，随机分为2组，观察组（n=178），对照组（n=134）。对比研究2组患者的机械通气治疗时间、神经功能缺损程度评分、APACHEⅡ评分值、并发症、动脉血气指标的变化及预后情况。结果2组患者机械通气后PaO2、PaCO2、SaO2等血气指标均有改善，但观察组通气效果更好，通气时间更短，并发症更少，差异均有统计学意义（均P〈0．05）；极严重缺陷和严重缺陷占幸存者比例下降，轻度缺陷和自理占幸存者比例上升，差异均有统计学意义（均P〈0．05）。结论早期机械通气较延迟机械通气能更有效改善急性脑卒中伴中枢性呼吸衰竭患者呼吸和缺氧状态，缩短机械通气时间及改善预后。Objective To compare theanalyze the effects of early mechanical ventilation and those of delayed mechanical ventilation in patients of acute cerebral stroke complicated with central respiratory failure. Methods 312 patients of acute cerebral stroke complicated with central respiratory failure undergoing mechanical ventilation were randomly divided into 2 groups： early mechanical ventilation group （Group A, n=178） receiving mechanical ventilation within 24-48 h after admission immediately when symptoms and signs of respiratory failure appeared, and delayed ventilation group （Group B, n=134）, receiving mechanical ventilation （26.80 ± 15.67） h after the symptoms and signs of respiratory failure appeared. The time needed for mechanical ventilation, neurological dysfunction scores, acute physiology and chronic health evaluation （APACHE） Ⅱ score, complications, blood gas analysis, and prognosis of these 2 groups were compared. Results The time needed for mechanical ventilation of Group A was （92.77 ± 46.82）h, significantly shorter than that of Group B [（154.58 ± 61.17）h, P〈 0.05]. The neurological defect score after the ventilation of Group A was （21.3±4.4）, significantly lower than that of Group B [（28.2±5.7）, P〈 0.05]. The blood gas indexes： partial pressure of oxygen in artery （PaO2）, partial pressure of carbon dioxide in artery （PaCO2）, and arterial oxygen saturation （SaO2） after mechanical ventilation of both groups were all improved compared with those before the mechanical ventilation （all P〈0.05）, and the indexes were improved more significantly in Group A than in Group B （all P〈0.05）. The APACHE Ⅱ scores after the ventilation of both groups were significantly, lower than those before the ventilation （both P〈 0.05）, and the APACHE Ⅱ scores after the ventilation of Group A was significantly lower than that of Group B （P〈 0.05）. There was not significant difference in the mortality between Groups A and B （17.42% vs 24.63%, P�

关 键 词：早期机械通气 延迟机械通气 急性脑卒中 中枢性呼吸衰竭 

分 类 号：R563.8[医药卫生—呼吸系统]