论文部分内容阅读
目的 探讨无创或与有创交替机械通气治疗吸入强酸气体致急性肺损伤 /急性呼吸窘迫综合征 (ALI/ARDS)的通气方式选择和交替时机的确定以及治疗价值。方法 回顾性分析 2 0 0 0 - 0 5～ 2 0 0 4 - 0 3我们收治吸入强酸气体致ALI/ARDS 9例临床资料。机械通气 (MV)配合常规药物治疗 ,MV方式为首先采用无创通气 (NIV) ,严密监护 ,将呼吸频率 (RR)、氧合指数 (OI)作为判断疗效的主要指标 ,与NIV前比较 ,2 4h内RR上升≥ 2 5 %、OI下降≥ 2 5 % ,或无改善 ,判断为第一交替点出现 ,换用有创MV ,此后RR、OI较NIV前分别下降≥ 2 5 %、上升≥ 2 5 %时 ,判断为第二交替点出现 ,再换用NIV。结果 6例在NIV时出现第 1交替点 ,均实施NIV—有创MV—NIV交替的MV方式 ,总MV平均时间 6 0± 2 1h ,其中有创MV平均时间 13± 7h ,占总MV时间的 2 2 % (13± 7/ 6 0± 2 1) ,3例未出现第 1交替点 ,持续NIV ,均获治愈顺利撤机 ,其通气平均时间 5 6± 2 8h。有 1例NIV时并发胃充气扩张 ,经处理未影响治疗。无第 2次使用有创MV ,未发生通气机相关性肺炎 (VAP)等并发症。结论 NIV或与有创交替MV的方式 ,使二者优势互补 ,并发症少 ,疗效好 ,可作为ALI/ARDS的理想通气方式。
Objective To investigate the choice of ventilation mode and the timing of alternation between noninvasive and invasive mechanical ventilation in the treatment of acute lung injury / acute respiratory distress syndrome (ALI / ARDS) induced by inhaled strong acid gas and its therapeutic value. Methods We retrospectively analyzed 9 cases of ALI / ARDS caused by inhaled strong acid gas from 2000-2005-2004-033. Mechanical ventilation (MV) was used in combination with conventional medical therapy. The MV method adopted noninvasive ventilation (NIV) and close monitoring. The respiratory rate (RR) and oxygenation index (OI) were used as the main indicators to evaluate the curative effect. 4h RR rise ≥ 25%, OI decreased ≥ 25%, or no improvement, to determine the first alternating point appears, with invasive MV, then RR, OI decreased more than 25% before NIV, increased ≥ 2 5%, it is determined that the second alternating point appears, and then use NIV. Results The first alternation point occurred in 6 cases at NIV. All patients underwent NIV-invasive MV-NIV alternation MV. The total MV time was 60 ± 2 1 h, and the mean time of invasive MV was 13 ± 7 h, accounting for the total MV time (13 ± 7/6 0 ± 21). The first alternation point did not appear in 3 cases and sustained NIV. All patients were cured and weaned smoothly. The average time of ventilatory ventilation was 56 ± 2 8 hours. A case of NIV complicated with gastric dilatation, treatment did not affect the treatment. No second use of invasive MV, no complications such as Ventilator-Associated Pneumonia (VAP). Conclusion NIV or MV with invasive alternative means that the two complementary advantages, fewer complications, good efficacy, can be used as an ideal ALI / ARDS ventilation.