CAJ | 학술논문

目的：探讨采用无创正压通气治疗急性重症哮喘致呼吸衰竭的临床疗效。方法回顾性分析某院急诊科2009年6月－2014年5月收治的47例重症哮喘合并呼吸衰竭患者的临床资料，分为对照组（26例）和观察组（21例），对照组采用吸氧、解痉、激素抗炎、平喘、祛痰等常规急救处理措施，观察组在对照组的基础上实施无创正压通气治疗。比较两组疗效、血气指标、血清炎症因子指标。结果入院时两组患者心率（ HR）、呼吸（ RR）、动脉血氧分压（ PaO2）、动脉血二氧化碳分压（PaCO2）、酸碱值（pH值）、白细胞介素－8（IL－8）、白细胞介素－17（IL－17）、嗜酸性粒细胞粒子蛋白（ECP）、中性粒细胞过氧化物酶（MPO）、巨噬细胞衍生趋化因子（MDC）差异均无统计学意义（P＞0．05）；治疗后24 h、72 h观察组HR、RR、PaCO2显著低于对照组（ P＜0．05）， PaO2显著高于对照组（ P＜0．05）。72 h后观察组IL－8、IL－17、ECP、MPO、MDC均显著低于对照组（ P＜0．05）。经过治疗后观察组有效率（66．67％）显著高于对照组（34．62％）（P＜0．05），观察组转入有创通气治疗率（28．57％）显著低于对照组（57．69％）（P＜0．05），两组患者病死率差异无统计学意义（P＞0．05）。结论无创正压通气治疗急性重症哮喘致呼吸衰竭患者较常规治疗能够显著改善患者血气、炎症因子指标，降低转有创机械通气治疗比例，提高临床疗效。
목적：탐토채용무창정압통기치료급성중증효천치호흡쇠갈적림상료효。방법회고성분석모원급진과2009년6월－2014년5월수치적47례중증효천합병호흡쇠갈환자적림상자료，분위대조조（26례）화관찰조（21례），대조조채용흡양、해경、격소항염、평천、거담등상규급구처리조시，관찰조재대조조적기출상실시무창정압통기치료。비교량조료효、혈기지표、혈청염증인자지표。결과입원시량조환자심솔（ HR）、호흡（ RR）、동맥혈양분압（ PaO2）、동맥혈이양화탄분압（PaCO2）、산감치（pH치）、백세포개소－8（IL－8）、백세포개소－17（IL－17）、기산성립세포입자단백（ECP）、중성립세포과양화물매（MPO）、거서세포연생추화인자（MDC）차이균무통계학의의（P＞0．05）；치료후24 h、72 h관찰조HR、RR、PaCO2현저저우대조조（ P＜0．05）， PaO2현저고우대조조（ P＜0．05）。72 h후관찰조IL－8、IL－17、ECP、MPO、MDC균현저저우대조조（ P＜0．05）。경과치료후관찰조유효솔（66．67％）현저고우대조조（34．62％）（P＜0．05），관찰조전입유창통기치료솔（28．57％）현저저우대조조（57．69％）（P＜0．05），량조환자병사솔차이무통계학의의（P＞0．05）。결론무창정압통기치료급성중증효천치호흡쇠갈환자교상규치료능구현저개선환자혈기、염증인자지표，강저전유창궤계통기치료비례，제고림상료효。
Objective To evaluate the clinical efficacy of noninvasive positive pressure ventilation for acute respiratory failure caused by severe asthma.Methods Retrospective analysis were adopted in 47 cases of severe asthma patients with respiratory failure in the emergency department of hospital from June 2009 to May 2014.They were divided into control group (26 cases) and study group (21 cases) according to the treatment methods.The control group used oxygen, spasmolysis, anti-inflammatory, expectorant, and other routine emergency treatment measures.The study group was implement with noninvasive positive pressure ventilation on the base of the control group.Compared indexes of curative effect, blood gas and serum inflammatory factors between the two groups.Results HR, RR, PaO2 , PaCO2 , PH value, IL-8, IL-17, ECP, MPO, MDC between the two groups of patients when admission were not significant (P>0.05);HR, RR number, PaCO2 value of the study group after treatment for 24 h and 48 h was significantly lower than control group (P<0.05) and PaO2 was significantly higher than the control group (P<0.05).After treatment for 72 h, IL-8, IL-17, ECP, MPO, MDC of the study group were significantly lower than the conventional group patients (P<0.05).After treatment, the effective rate of 66.67%in study group was significantly higher than that 34.62%of the control group (P<0.05).The study group of 28.57%invasive ventilation proportion was significantly lower than that of 57.69%in the control group (P<0.05).Mortality between the two groups was not significant (P>0.05).Conclusion Noninvasive positive pressure ventilation may improved the patient’s blood, in-flammatory cytokines indicators, reduce the proportion of invasive mechanical ventilation and improve clinical outcomes in patients with acute respiratory failure caused by severe asthma compared with conventional treatment.