无创正压通气与有创通气治疗淹溺者并急性呼吸窘迫综合征的疗效比较(1)
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【摘要】目的观察比较无创正压通气与有创通气治疗淹溺者并急性呼吸窘迫综合征的治疗效果。方法63例淹溺并急性呼吸窘迫综合征患者随机分为A、B两组,A组为无创正压通气组,B组为有创通气组,分别给予无创正压通气治疗和有创通气治疗,观察两种通气方法的治疗效果。结果与治疗前比较机械通气0.5 h、1 h、4 h、12 h后两组pH、PaO2、PaCO2及HR、RR均明显改善(P<0.05)。B组HR、RR在机械通气0.5 h、1 h后下降较A组快,但在机械通气4 h后两组HR、RR变化一致。这与B组气管插管时应用镇静麻醉剂或肌肉松弛剂有关。A组机械通气时间、总住院时间均短于B组(P<0.05),A组平均住院费用、呼吸机相关肺炎发生率少于B组(P<0.05),治愈率两组无明显差别。结论无创正压通气方法和有创通气方法治疗淹溺者并急性呼吸窘迫综合征均有较好的治疗效果,无创正压通气方法优于有创通气方法。
【关键词】
无创正压通气;有创通气;淹溺;急性呼吸窘迫综合征
A comparison between NIPPV and IV on the drowned with ARDS
WU Liang,GUO Qing,FENG Yiwei.Department of Respiratory Medicine of Gaozhou People’s Hospital,Guangdong 525200,China
【Abstract】ObjectiveTo observe and compare the effect of the treatment using NIPPV(noninvasive positive pressure ventilation)or IV(invasive ventilation)on the drowned with ARDS(acute respiratory distress syndrome).Methods63 patients into two groupsgroup A(NIPPV)and group B(IV).The effects of the two ventilations wrer obserred.ResultspH,PaO2,PaCO2 and HR,RR in the two groups were all improved(P<0.05)after machinery ventilating for 0.5 h,1 h,4 hs and 12 hs.HR and RR in group B dropped faster than those in group A after machinery ventilating for 0.5 h,and 1 h,but consistent for 4 hs.This concerned muscle relaxants or the sedative anesthetics used when intubating in group B.The time of machinery ventilating and the treatment of group A was shorter than thoseof group B(P<0.05).The average expense of group A was smaller than group B and the pneumonia formation rate of lifesupport machine in group A was lower,too.Two groups were not obviously different in cure rate.ConclusionNIPPV and IV have a good treatment result for the drowned with ARDS,but NIPPV is better than IV.
【Key words】
Noninvasive positive pressure ventilation(NIPPV); Invasive ventilation(IV); Drowned; Acute respiratory distress syndrome(ARDS)
淹溺是内科急症。溺水后患者常并发急性呼吸窘迫综合征(ARDS),如治疗不及时,往往导致患者死亡。对于溺水患者并ARDS,机械通气是最重要的支持治疗方法。经鼻/面罩无创正压通气避免或减少有创正压通气的并发症,如创伤、需要镇静、呼吸机相关肺炎等,使其日益得到重视[2]。本研究就无创正压通气与有创通气治疗淹溺者合并ARDS的疗效进行探讨,以评价两者在治疗淹溺者合并ARDS的疗效。
1资料与方法
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