中国临床医学
中國臨床醫學
중국림상의학
CLINICAL MEDICAL JOURNAL OF CHINA
2014年
3期
276-278
,共3页
急性呼吸窘迫综合征%双水平气道正压通气%序贯性机械通气%控制窗
急性呼吸窘迫綜閤徵%雙水平氣道正壓通氣%序貫性機械通氣%控製窗
급성호흡군박종합정%쌍수평기도정압통기%서관성궤계통기%공제창
Acute respiratory distress syndrome%Bi-level positive airway pressure ventilation%Sequential mechanical ventilation%Control window
目的：探讨有创与无创双水平气道正压通气（bi-level positive airway pressure ，BiPAP）序贯治疗急性呼吸窘迫综合征（acute respiratory distress syndrome ，ARDS）的疗效。方法：将重症监护病房（intensive care unit ，ICU）76例ARDS患者随机分为有创与无创BiPAP序贯治疗组（A组）38例和常规同步间歇指令通气（synchronized intermittent mandatory ventilation ， SIMV）组（B组）38例。所有患者均按ARDS常规治疗，尽早气管插管行SIMV ，当“ARDS控制窗”出现时，A组拔除气管插管，改用鼻面罩无创BiPAP序贯治疗，B组继续SIMV治疗，以SIMV＋压力支持通气（pressure support ventilation ，PSV）模式撤机。结果：2组患者“ARDS控制窗”出现时间、生命体征的指标和动脉血气分析的指标比较差异均无统计学意义（ P＞0．05）；与B组比较，A组有创通气时间及总机械通气时间均减少，入住ICU时间缩短，呼吸机相关性肺炎（ventilator associat-ed pneumonia ，VAP）发生率、病死率均降低（P＜0．05）。结论：有创与无创BiPAP序贯治疗ARDS的疗效显著，可明显缩短机械通气时间，降低VAP发生率及病死率。
目的：探討有創與無創雙水平氣道正壓通氣（bi-level positive airway pressure ，BiPAP）序貫治療急性呼吸窘迫綜閤徵（acute respiratory distress syndrome ，ARDS）的療效。方法：將重癥鑑護病房（intensive care unit ，ICU）76例ARDS患者隨機分為有創與無創BiPAP序貫治療組（A組）38例和常規同步間歇指令通氣（synchronized intermittent mandatory ventilation ， SIMV）組（B組）38例。所有患者均按ARDS常規治療，儘早氣管插管行SIMV ，噹“ARDS控製窗”齣現時，A組拔除氣管插管，改用鼻麵罩無創BiPAP序貫治療，B組繼續SIMV治療，以SIMV＋壓力支持通氣（pressure support ventilation ，PSV）模式撤機。結果：2組患者“ARDS控製窗”齣現時間、生命體徵的指標和動脈血氣分析的指標比較差異均無統計學意義（ P＞0．05）；與B組比較，A組有創通氣時間及總機械通氣時間均減少，入住ICU時間縮短，呼吸機相關性肺炎（ventilator associat-ed pneumonia ，VAP）髮生率、病死率均降低（P＜0．05）。結論：有創與無創BiPAP序貫治療ARDS的療效顯著，可明顯縮短機械通氣時間，降低VAP髮生率及病死率。
목적：탐토유창여무창쌍수평기도정압통기（bi-level positive airway pressure ，BiPAP）서관치료급성호흡군박종합정（acute respiratory distress syndrome ，ARDS）적료효。방법：장중증감호병방（intensive care unit ，ICU）76례ARDS환자수궤분위유창여무창BiPAP서관치료조（A조）38례화상규동보간헐지령통기（synchronized intermittent mandatory ventilation ， SIMV）조（B조）38례。소유환자균안ARDS상규치료，진조기관삽관행SIMV ，당“ARDS공제창”출현시，A조발제기관삽관，개용비면조무창BiPAP서관치료，B조계속SIMV치료，이SIMV＋압력지지통기（pressure support ventilation ，PSV）모식철궤。결과：2조환자“ARDS공제창”출현시간、생명체정적지표화동맥혈기분석적지표비교차이균무통계학의의（ P＞0．05）；여B조비교，A조유창통기시간급총궤계통기시간균감소，입주ICU시간축단，호흡궤상관성폐염（ventilator associat-ed pneumonia ，VAP）발생솔、병사솔균강저（P＜0．05）。결론：유창여무창BiPAP서관치료ARDS적료효현저，가명현축단궤계통기시간，강저VAP발생솔급병사솔。
Objective:To investigate the efficacy of sequential use of invasive and non-invasive bi-level positive airway pressure (BiPAP) ventilation in the treatment of acute respiratory distress syndrome (ARDS) .Methods :A total of 76 patients with ARDS of intensive care unit(ICU) were randomly divided into sequential treatment group with invasive and non-invasive BiPAP ventilation(group A ,n=38) and conventional synchronized intermittent mandatory ventilation (SIMV)group(group B ,n=38) . All patients with ARDS according to conventional therapy ,were early to be endotracheal intubation and SIMV .When the "ARDS control window”appeared in group A ,extubation was done and treatment was switched to sequential treatment of a nasal mask non-invasive BiPAP ventilation ,In group B ,SIMV was continued ,and weaned as model of SIMV+pressure support venti-lation(PSV) .Results:The time of the appearance of “ARDS control window” ,the indicators of vital signs ,and the indicators of arterial blood gas analisis in two groups were not statistically significant (P>0 .05) .Compared with that in group B ,the dura-tion of invasive mechanical ventilation and the total duration of mechanical ventilation were reduced ,the time in ICU was re-duced ,the incidence rate of ventilator associated pneumonia (VAP) and mortality rates in group A were lower (P<0 .05) .Con-clusions:The efficacy of sequential use of the invasive and non-invasive BiPAP ventilation in the treatment of ARDS is signifi-cant ,and can significantly shorten the duration of mechanical ventilation ,and to reduce the incidence of VAP and mortality .
