论文部分内容阅读
目的：评价经面罩机械通气治疗慢性阻塞性肺病（慢阻肺）呼吸衰竭昏迷患者的疗效。方法：１３例慢阻肺呼吸衰竭昏迷患者经面罩压力支持通气，并与同期１６例非昏迷患者比较。结果：昏迷患者通气２～４小时后，ｐＨ值从７．２３１±０．０５４升至７．３７６±０．０７３，ＰａＣＯ２从１２．０３±１．８３ｋＰａ（１ｋＰａ＝７．５ｍｍＨｇ）降至９．３６±１．９４ｋＰａ；且多数患者意识转清，并恢复正常的咳痰能力；合并电解质紊乱者治疗反应较差。８５％的患者平均通气１３天后恢复至稳定的自主呼吸状态和较满意的动脉血气水平。与非昏迷患者比较疗效相似（Ｐ＞０．０５），但较多患者需改用辅助／控制模式通气，且有较高的胃胀气发生率。结论：昏迷不应是面罩通气的禁忌证；加强昏迷患者意识清醒前呼吸道分泌物的清除及胃胀气的引流，合理选用机械通气模式是成功的关键。
OBJECTIVE: To evaluate the curative effect of masked mechanical ventilation on patients with coma of chronic obstructive pulmonary disease (COPD) respiratory failure. Methods: Thirteen patients with COPD with respiratory failure and coma ventilated with mask pressure and compared with 16 non-comatose patients during the same period. Results: After 2 to 4 hours of ventilation, the coma of patients in coma rose from 7.231 ± 0.054 to 7.376 ± 0.073, PaCO2 decreased from 12.03 ± 1.83kPa (1kPa = 7.5mmHg) to 9 .36 ± 1.94kPa; and the majority of patients with consciousness clear, and restore normal sputum capacity; treatment of electrolyte imbalance with poor response. 85% of patients returned to stable spontaneous breathing state and more satisfactory arterial blood gas level after 13 days of average ventilation. Compared with non-coma patients were similar (P> 0.05), but more patients need to switch to the auxiliary / control mode ventilation, and have a higher incidence of flatulence. Conclusion: Coma should not be a contraindication to mask ventilation. To strengthen the clearance of respiratory secretions and flatulence of gas before conscious consciousness of coma patients, rational selection of mechanical ventilation mode is the key to success.