非侵入性面罩机械通气治疗重症支气管哮喘

目的：探讨非侵入性面罩机械通气方法治疗重症支气管哮喘的机制、上机和脱机指征以及治疗过程中应注意的问题。方法：采用非侵入性面罩方法，在自主呼吸条件下联合应用压力支持通气（ＰＳＶ）、呼气末正压（ＰＥＥＰ）和持续气流（ＢｉａｓＦｌｏｗ）通气模式治疗了９例重症支气管哮喘患者。结果：非侵入性面罩机械通气方法对此组患者的临床征象有显著改善，无任何并发症发生。各种生理多功能监测指标和动脉血气在治疗前后也有明显差异（Ｐ均＜０．０１）。结论：非侵入性面罩机械通气方法是一种在重症支气管哮喘危及生命情况下可供选择的、有效的治疗手段，对急诊危重患者的抢救、为进一步专科治疗争取宝贵的时间、减少病死率等均有重要意义。非侵入性面罩机械通气治疗重症支气管哮喘较经鼻气管插管方法有易于操作、不损害上呼吸道防御功能、减少误吸及无创伤等优点。

The treatment of severe bronchial asthma with non invasive mask mechanical ventilation/

Objective:To investigate the potential advantage of noninvasive mask mechanical ventilation in treatment of severe bronchial asthma,the indication of using respirator and problems during ventilation.Methods:We used the method of noninvasive mask mechanical ventilation,combined pressure support ventilation (PSV),positive endexpiratory pressure (PEEP) and continuous flow (Bias Flow),to treat 9 cases of severe bronchial asthma.Results:Noninvasive mask mechanical ventilation could markedly improve clinical signs without complications in all cases.The index of physiologic multifunction monitor and blood gas analysis showed that there was remarkable difference between pretreatment and posttreatment in PaO 2,PaCO 2,SaO 2,RR,and HR(all P <0.01).Conclusions:Our data suggest that noninvasive mask mechanical ventilation appears to be a useful method in the treatment of severe bronchial asthma and other critical illness.In this study,we also disscused the mechanism of treating severe bronchial asthma,the indications of using respirator and the problems that we should pay attention to,by combined using PSV,PEEP and Bias Flow ventilation method under the autonomous respiratory condition.Comparing with the method of nasotracheal intubation,this method had more advantages,such as easy operation,noninterference with upper respiratory defense function,reduction of accidental aspiration and noninvasiveness of examination.