CAJ | 학술논문

　　目的：探讨无创正压通气（NPPV）治疗重度支气管哮喘的效果和并发症。方法：70例重度急性哮喘患者随机接受常规治疗（对照组，n＝39）或在常规治疗的基础上加用 NPPV 治疗（治疗组，n＝31）。比较两组临床症状、生命体征及血气分析的变化，气管插管率的差异和NPPV相关的并发症。结果：治疗组临床症状迅速缓解，气管插管3．2％明显低于对照组的20．5％（P ＜0．05）。治疗组HR 和RR（4 h 和8 h 时间点）比对照组改善更明显（P＜0．05），治疗组治疗2 h后pH及PaO2/FiO2有明显改善（P ＜0．05），对照组在治疗4 h后才有明显改善（P ＜0．05）。治疗后，治疗组pH（2 h和4 h时间点）、PaO2/FiO2（2 h和8 h时间点）、PaCO2明显优于对照组（P ＜0．05）。NPPV相关的不良反应发生率为16．1％，无严重并发症发生。结论：在重度急性哮喘发作的早期，在常规治疗的基础上加用NPPV可迅速改善患者症状，降低气管插管率，改善呼吸窘迫和降低心率，提高患者的呼吸功能。
　　목적：탐토무창정압통기（NPPV）치료중도지기관효천적효과화병발증。방법：70례중도급성효천환자수궤접수상규치료（대조조，n＝39）혹재상규치료적기출상가용 NPPV 치료（치료조，n＝31）。비교량조림상증상、생명체정급혈기분석적변화，기관삽관솔적차이화NPPV상관적병발증。결과：치료조림상증상신속완해，기관삽관3．2％명현저우대조조적20．5％（P ＜0．05）。치료조HR 화RR（4 h 화8 h 시간점）비대조조개선경명현（P＜0．05），치료조치료2 h후pH급PaO2/FiO2유명현개선（P ＜0．05），대조조재치료4 h후재유명현개선（P ＜0．05）。치료후，치료조pH（2 h화4 h시간점）、PaO2/FiO2（2 h화8 h시간점）、PaCO2명현우우대조조（P ＜0．05）。NPPV상관적불량반응발생솔위16．1％，무엄중병발증발생。결론：재중도급성효천발작적조기，재상규치료적기출상가용NPPV가신속개선환자증상，강저기관삽관솔，개선호흡군박화강저심솔，제고환자적호흡공능。
Objective:To explore the treatment effects and the complications of noninvasive positive-pressure ventilaiton (NPPV) on severe bronchial asthma. Methods: 70 patients with severe acute asthma were randomized to receive either standard medical therapy(the controlled group, n=39) or standard medical therapy in addition to NPPV (the treatment group,n=31).The changes of clinical symptoms,vital signs and arterial blood gas analysis, the rates of endotrachael intubation(ETI) and the complications related to NPPV were compared between the two groups. Result:The clinical symptoms in the treatment group promptly remitted. The rate of ETI in the ventilated group (3.2%) was significantly lower than that(20.5%) in the controlled group. After treatment, The heart rates(HR)(all time points) and respiratory rates(RR)(at time point of 4h and 8h ) in the ventilated group ameliorated better than the controlled group(P < 0.05).After treating for 2 hs,the values of pH and PaO2/FiO2 in ventilated group improved significantly (P< 0.05). The values of pH and PaO2/FiO2 in controlled group just improved after treating for 4 hs (P < 0.05).After treatment,the values of pH(at time points of 2 h and 4 h), PaO2/FiO2(at time points of 2 h and 8 h)and PaCO2(all time points) in the treatment group ameliorated better than the control group (P < 0.05).The rate of complication related to NPPV was 16.1% and no severe complications happened. Conclusions: During the early period of severe acute asthma attacks,the standard medical therapy in addition to NPPV would promptly improve the clinical symptoms of patients with asthmatic status,decrease the incidence of ETI,ameliorate respiratory distress,decrease heart rates and improve the pulmonary functions.