无创正压通气在多发伤并发ALI/ARDS中的临床应用

目的:探讨使用无创正压通气（Noninvasivepositivepressureventilation,NIPPV）治疗多发伤并发急性肺损伤/急性呼吸窘迫综合征（Acutelunginjury/acuterespiratorydistresssyndrome,ALI/ARDS）,总结双水平气道正压通气呼吸模式的临床应用。方法:回顾性分析75例多发伤并发ALI/ARDS患者使用NIPPV或有创机械通气（InvasivemechanicalventilationI,MV）的情况,比较两种通气方式治疗前及治疗后2h动脉血气分析变化及机械通气时间。结果:NIPPV40例,有创通气35例。无创通气组及有创通气组通气2h后病人动脉血氧分压（Arterialpartialpressureofoxygen,PaO2）及血氧饱和度（Oxygensaturation,SaO2）较通气前明显提高（P<0.0001）。无创通气组中5例无创通气3～5d（平均4.2d）后改IMV,4例因手术需全麻,先予以IMV20～36h后改为无创机械通气。35例无创通气3～18d[平均（8±5.5）d]成功脱机,无1例死亡。IMV组通气5～20d脱机[平均（9±5.5）d],无1例死亡。两组机械通气时间比较无统计学意义（P>0.05）。两组间动脉血气分析治疗前、治疗后变化比较无统计学意义（P>0.05）。结论:多发伤后合并ALI/ARDS早期应用NIPPV治疗,采用双水平气道正压通气的呼吸模式,不仅可取得与IMV治疗相同的效果,而且能减少并发症,提高病人的舒适性。

Clinical evaluation of noninvasive positive pressure ventilation in multiple injury patients with acute lung injury and acute respiratory distress syndrome

Objective:To explore the importance of noninvasive positive pressure ventilation(NIPPV) in treating patients suffered from multiple injury accompanied with acute lung injury(ALI)/acute respiratory distress syndrome(ARDS),and summarize the clinical usage of bi-level airway pressure ventilation mode in the treatment.Methods:The 75 cases with multiple injury complicated with ALI/ARDS were analyzed retrospectively and the following two groups were obtained:the positive pressure ventilation group,in abbreviation NIPPV,and the invasive mechanical ventilation group,in abbreviation IMV.The changes of arterial blood gas individually before and after 2 h treatment and the duration of using ventilation were compared between the two groups.Results:40 cases were enrolled into NIPPV group,and 35 cases belong to IMV group.The arterial partial pressure of oxygen(PaO2) and arterial oxygen saturation(SaO2) had significantly improved after 2 h NIPPV or IMV treatment(both P <0.000 1).5 patients changed to IMV after 3～5 days NIPPV(average=4.2 d)according to their conditions.4 patients who needed general anesthesia operations were given IMV for 20～36 h,then were changed to NIPPV.Duration of using NIPPV were 3～18 d(average=(8±5.5) d),and duration of using IMV were 5～20 d(average=(9±5.5) d).The changes of arterial blood gas showed no significant difference between NIPPV and IMV at the statistic level of P>0.05.No patient died in two groups.Conclusion:The use of bi-level airway pressure ventilation on NIPPV mode in early stage of multiple injury patients with ALI/ARDS not only has same effect as using IMV,but also can reduce complications and improve patients’ comfortableness.