呼吸机辅助呼吸治疗肾移植术后重症肺炎的体会并文献复习  

Respirator assisted ventilation in treating patients with severe pneumonia after renal transplantation: experience and literature review

作　　者：高建 姜伟 刘彦斌 禹猛 杨其顺 

机构地区：[1]解放军第281医院泌尿外科,河北秦皇岛066100

出　　处：《器官移植》2013年第5期299-303,共5页Organ Transplantation

摘　　要：目的探讨呼吸机辅助呼吸对肾移植术后重症肺炎并发呼吸衰竭患者的治疗价值。方法 4例患者中男3例,女1例,平均年龄50岁。除给予常规治疗外,使用纽邦E360呼吸机给予辅助呼吸。有创通气2例,无创通气2例。有创通气采用同步间歇指令+压力支持通气模式;无创通气采用压力支持通气加呼吸末正压通气。严密观察患者病情变化,注意气管插管深度、气囊状态、面罩漏气程度等,及时给予调整呼吸机参数。同时积极治疗原发病,患者全身状况得到改善,体温正常,营养状态改善,导致呼吸衰竭的原发病因已解除或得到控制,肺部分泌物减少,呼吸肌力恢复较好,血液循环状态稳定后,从逐渐撤机过渡到完全撤机。结果 4例患者经治疗后,3例痊愈出院,1例死亡。3例痊愈患者的通气时间平均为15 d,其动脉血气分析指标、呼吸频率、心率均较通气前明显改善。在机械通气过程中,1例发生气胸,经予胸腔闭式引流后治愈。1例死亡患者合并糖尿病、肾癌等病史,有延误诊治史。结论经呼吸机辅助呼吸治疗肾移植术后重症肺炎并发呼吸衰竭患者疗效较好。Objective To investigate the value of respirator assisted ventilation in treating patients with severe pneumonia and respiratory failure after renal transplantation. Methods There were 3 males and 1 female with the average age of 50 years old. Besides giving regular treatment, NEWPORT E360 respirator was used to breathe with 2 cases of invasive ventilation and 2 cases of noninvasive ventilation. The mode of invasive ventilation was synchronous intermittent mandatory plus pressure support ventilation, and that of noninvasive ventilation was pressure support ventilation plus positive end pressure expiratory pressure. Patients＇ condition was closely observed. The endotracheal intubation depth, airbag condition and mask leakage were strictly monitored and the respirator parameters were adjusted timely. Meanwhile, the patients＇ primary diseases were treated. The patients＇ general condition was improved with normal temperature, improved nutrition status. The primary etiologies which leaded to respiratory failure were relieved or controlled. The lung secretion reduced, respiratory muscle strength recovered well, and hemodynamics became stable. And then the respirator was withdrawn gradually to completely. Results Three cases recovered and discharged after treatment and 1 case died. The average length of ventilation of 3 cases was 15 d. Their arterial blood gas analysis index, respiratory frequency and heart rate improved significantly after the ventilation. During mechanical ventilation, 1 case suffered pneumothorax and was cured through closed thoracic drainage. The dead case had the history of diabetes mellitus, kidney cancer and delayed diagnosis and treatment. Conclusions Severe pneumonia and respiratory failure after renal transplantation can be treated by respirator assisted ventilation with good outcome.

关 键 词：呼吸机 辅助呼吸 肾移植 呼吸衰竭 重症肺炎 

分 类 号：R617[医药卫生—外科学]