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目的 探讨允许性高碳酸的血症 (PHV)联用低呼气末正压 (PEEP)通气治疗危重哮喘的效果。方法 12例危重哮喘患者采用容量控制或辅助 /控制模式并采用PHV通气策略 (PaCO2 <10 .6kPa ,pH >7.15 )。2例患者采用SIMV和PEEP。潮气量设定 6～ 8ml/kg ,PEEP设在 5～ 10cmH2 O压力左右 ,呼吸频率为 14～ 16次 /min。同时记录吸入氧浓度 (FiO2 )、气道峰压 (PIP)、动脉血气 (ABG)、心率 (HR)和血压 (BP)。结果 治疗前 ,12例患者均处于呼吸衰竭及存在意识障碍 ,包括嗜唾和昏迷 ,患者机械通气前PaO2 为 (6 .18± 0 .6 4)kPa,血的 pH值为 (7.14± 0 .0 7) ,PaCO2 为 (10 .6± 1.5 3)kPa。在施行PHV联用PEEP模式 2～ 8h、2 4h、72h后 ,血pH值和PaO2 均明显升高 (P <0 .0 0 1)。而PaCO2 则在 72h内保持在正常水平的上限逐渐下降。 12例患者全部存活未发生并发症。结论 采用PHV联用低PEEP配合充分氧疗 ,逐步降低PaCO2 ,提高 pH至正常范围 ,是抢救重危哮喘的有效机械通气方法
Objective To investigate the effect of permissive hypercapnic (PHV) combined with low end expiratory pressure (PEEP) ventilation on critically ill asthma. Methods 12 patients with critically ill asthma were treated with volume control or adjuvant / control mode and PHV ventilation strategy (PaCO2 <10.6 kPa, pH> 7.15). Two patients used SIMV and PEEP. Tidal volume set 6 ~ 8ml / kg, PEEP set at about 5 ~ 10cmH2O pressure, respiratory rate of 14 to 16 beats / min. FiO2, PIP, ABG, HR and BP were recorded at the same time. Results Before treatment, all 12 patients were suffering from respiratory failure and unconsciousness, including salivary sphincter and coma. The PaO2 before mechanical ventilation was (6.18 ± 0.64) kPa and the blood pH was (7.14 ± 0). 0 7), PaCO2 is (10.6 ± 1.5 3) kPa. PHV combined PEEP mode 2 ~ 8h, 2 4h, 72h, the blood pH and PaO2 were significantly increased (P <0. 001). While PaCO2 decreased gradually within the upper limit of normal level maintained within 72 hours. All 12 patients survived without complications. Conclusion PHV combined with low PEEP with adequate oxygen therapy, and gradually reduce the PaCO2, raise the pH to the normal range, is an effective mechanical ventilation rescue severe asthma