无创与有创正压通气对危重肺心病呼吸衰竭患者的疗效评价  

Non-invasive pressure support ventilation and invasive pressure support ventilation in severe cor pulmonale induced respiratory failure

作　　者：金发光[1] 钱桂生[2] 谢永宏[1] 楚东岭[1] 傅恩清[1] 刘同刚[1] 

机构地区：[1]中国人民解放军第四军医大学第二附属医院唐都医院呼吸内科,陕西西安710038 [2]中国人民解放军第三军医大学新桥医院呼吸内科研究所,重庆400037

出　　处：《中国急救医学》2004年第2期90-91,共2页Chinese Journal of Critical Care Medicine

基　　金：全军"十五"重点课题资助项目 (No .0 1Z0 74)

摘　　要：目的　评价无创与有创正压通气在危重肺心病呼吸衰竭患者中的治疗效果。方法　 2 0例危重肺心病呼吸衰竭患者随机分为A组和B组 ,每组 10例。A组进行有创通气和常规药物治疗 ,B组进行无创通气和常规药物治疗。结果　A组进行有创通气 2 4h后 ,10例患者均明显好转 ,呼吸频率、心率下降 ,PaO2 上升 ,PaCO2 下降 ,与治疗前比较均有显著差异 (P <0 .0 1)。人工机械通气天数平均为 (9± 4 )d ,住院天数平均为 (15± 5 )d。 10例患者 9例出院 ,1例因呼吸机依赖而死亡。B组无创通气 2 4h后仅 1例治疗有效 ,4例无明显变化 ,5例病情恶化。 9例患者均在 36h之内改为有创通气 ,其中 1例在气管插管时因心跳呼吸骤停死亡 ,2例在有创通气过程中死亡 ,余 6例患者均平稳撤机。人工机械通气天数平均为 (15± 6 )d ,住院天数平均为 (2 1± 6 )d ,与A组比较有显著差异性 (P <0 .0 5 )。结论　危重肺心病呼吸衰竭患者不宜选用无创正压通气 ,应尽早气管插管进行有创通气治疗。Objective To estimate the efficacy of non-invasive and invasive pressure support ventilation in cor pulmonale induced respiratory failure. Method 20 cases with severe cor pulmonale induced respiratory failure were divided into two groups at random, Group A(n=10) were treated with invasive pressure support ventilation and routine drug, and Group B (n=10) were treated with invasive pressure support ventilation. Results For Group A, after 24 hours of invasive pressure support ventilation, all the cases felt better, and got slower breathing rate and heart rate, higher PaO 2, and lower PaCO 2(P<0.01), the duration of pressure support ventilation was (9±4)d, the duration of hospital stay was (10±5)d. 9 cases in Group A were cured successfully, 1 died from dependence on ventilator. For Group B, after 24 hours of non-invasive pressure support ventilation, only one turned better, 4 cases had no significant changes, the condition of 5 cases aggravated. All these 9 cases were forced to use invasive ventilation within 36 hours, one of them died of cardiac arrest during the endotracheal intubation ,two died during the proccess of invasive pressure support ventilation,and the rest 6 got safe removement of ventilator after the duration of mechanical ventilation. The duration of pressure support ventilation was (11±6)d, the duration of hospital stay was (21±6)d. The difference between Group A and Group B was significant. Conclusion In cor pulmonale induced severe respiratory failure, we prefer to choose endotracheal intubation and pressure support ventilation as early as possible rather than non-invasive pressure support ventilation.

关 键 词：肺心病 呼吸衰竭 人工机械通气 

分 类 号：R563.8[医药卫生—呼吸系统]