摘要
目的 探讨严重急性呼吸综合征 (severeacuterespiratorysyndrome ,SARS)患者应用有创通气治疗过程中的策略。方法 1 2例重症SARS患者 ,男 8例 ,女 4例 ,年龄 (31± 75 )岁 ,平均 (5 1 3± 1 1 0 )岁。常规治疗和无创通气失败后 ,经鼻气管插管进行有创人工通气 ,采用压力控制通气模式 ,通气过程中予以镇静。监测通气前后和充分镇静后的生命体征和血气分析 ,氧合功能的变化 ,对通气过程中的并发症和患者的转归进行分析。结果 (1 ) 1 2例患者均高热 (体温 >38 5℃ ) ,1 0例 (83 3% )患者的WBC总数在正常范围 ,仅 1例高于正常。合并其他脏器损害 9例 (75 % )。 (2 )应用模式为压力调节 +呼气末正压 ,即PCV +PEEP或PRVC +PEEP ,起始PCV的压力为 (1 7 2± 2 9)cmH2 O ,PEEP的压力为 (9 8± 3 5 )cmH2 O ,平均通气时间为 (1 4 7± 1 1 2 )d。 (3)静脉应用咪唑安定或异丙酚充分镇静后可使患者的呼吸频率(RR)下降 ,氧合指数 (OI)升高 ,避免了因吸痰等引起的SpO2 的下降。通气前有 1例患者出现气胸 ,通气过程中 1例出现双侧气胸并纵膈气肿。 (4 )全部患者均接受了皮质激素治疗 ,剂量 2 4 0 - 5 0 0mg d (5 0 0mg d 6例 )。 (5 ) 8例患者成功撤离人工通气并拔除人工气道 ,4例死亡。死亡病例均有严重基础?
Objective To study a strategy of mechanical ventilation for patients with critically severe acute respiratory syndrome( SARS). Methods Twelve patients with critically SARS(8 males and 4 females), aged from 31 to 75 years (mean age 51 3±11 0 yrs), were enrolled in the study. After failure of routine treatment and non invasive ventilation initiatively, all patients were intubated for intermittent positive pressure ventilation (IPPV) (PCV/PRVC+PEEP), with sedation during ventilation. The vital sign, blood gas analysis and the oxygenation function were observed before and after ventilation, and after sedation. The complications and prognosis were evaluated. Results (1) All patients had high fever(T>38 5℃), ten showed normal white blood cell counts (<10×10 9/L), and nine had dysfunction of other organs. (2) All patients used the pattern of PCV/PRVC+PEEP,the initiative pressure of PCV was(17 2±2 9)cm H 2O and the pressure of PEEP was(9 8±3 5) cm H 2O (3) After completely sedated with venous injection of midazolam or propofol, the patients' respiratory rate was decreased, along with the increase of the oxygen index (OI) and maintenance of SpO 2 during the airway management. One patient had the pneumothorax before ventilation. The bilateral pneumothorax and pneumomediastinum occurred in one patient due to insufficient sedation during ventilation. (4) All patients received corticosteroid (methylprednisonlone, 240 to 500 mg/d). (5) Eight patients weaned from mechanical ventilation and extubated successfully. Four patients died of severe diseases and complications. Conclusion The use of mechanical ventilation in patients with critically SARS may increase the rescue rate. The use of the pattern of PCV and the appropriate PEEP may improve the oxygenation and reduce lung injury because of overdistention. Sufficient sedation should be emphasized on during the mechanical ventilation. PEEP should be maintained until the oxygenation improved.
出处
《中华急诊医学杂志》
CAS
CSCD
2003年第6期369-372,共4页
Chinese Journal of Emergency Medicine
