不同呼吸支持方式在危重症患者抢救中的价值比较

目的 探讨危重症抢救中呼吸支持的使用率及呼吸支持使用时间和方式与抢救成功率间的关系.方法 对458例接受呼吸支持的危重症患者临床资料进行分层分析,其中心搏、呼吸骤停47例,急性呼吸道阻塞105例,急性呼吸衰竭(呼衰)156例,慢性呼衰150例.分别进行气管插管、气管切开、无创口鼻/面罩通气,统计各组患者不同呼吸支持方式的抢救成功率与疾病、呼吸支持时间的关系.结果 呼吸支持治疗期间死亡117例(25.5%),放弃治疗49例,成功脱离呼吸机292例(63.8%).心搏、呼吸骤停患者复苏及呼吸支持抢救成功率为21.3%(10/47),按病因分类,急性呼吸道阻塞导致的呼衰抢救成功率为82.8%(87/105),急性呼衰的抢救成功率为55.1%(86/156),慢性呼衰合并肺性脑病患者呼吸支持成功率为72.7%(109/150).有创和无创呼吸支持的早期成功率分别为95.0%(57/60)和95.5%(21/22),较早期为81.7%(68/82)和69.0%(20/29),中期为65.6%(63/96)和48.1%(13/27),晚期为44.4%(40/90)和0(0/5),抢救成功率均随抢救开始时间的延迟而显著下降(P均<0.01).结论 呼吸支持的关键是尽早、及时进行有效呼吸支持,人工气道建立的困难和风险是不能早期使用呼吸支持的重要因素.

Clinical analysis of value of different modes of respiratory support in the treatment of critical patients

Objective To investigate the relationship between the successful results with different methods and time of initiation of respiratory support in critically ill patients.Methods The clinical data of 458 critical care patients were reviewed and analyzed.Among the patients,there were 47 cases of cardiopulmonary resuscitation,105 cases of acute airway obstruction,156 cases of acute respiratory failure,and 150 cases of chronic respiratory failure.Intubation,or tracheostomy,or non-invasive positive pressure ventilation(NPPV)at different times and occasions were performed in the patients.Results One hundred and seventeen cases(25.5%)died during the respiratory support treatment,49 cases gave up the treatment,and 292 patients(63.8%)were cured after mechanical ventilation.As the success rate was the lowest in patients who survived cardio-pulmonary resuscitation(21.3%,10/47),it was higher in acute respiratory failure(55.1 %,86/156),and the best result(82.8%,87/105)was obtained in the acute airway obstruction group and patients with chronic respiratory failure(72.7%,109/150).In the group of patients undergoing early respiratory support,the cure rate was 95.0%(57/60)in patients with invasive method,and 95.5% (21/22)in the NPPV group.The result was significantly different compared with that of later treatment group C81.7%(68/82)in invasive group,and 60.9%(2/29)in NPPV group,both P<0.013.It demonstrated that the earlier the respiratory support was given the better results.If the respiratory support was delayed,cure rate was significantly reduced65.6%(63/96)in invasive group and 48.1%(13/27)in NPPV group,both P<0.01].The cure rate was no difference between different modes of respiratory support between early treatment groups,however,invasive respiratory support was much better than NPPV C44.4%(40/90)and 0(0/5)]when instituted in the late stages(all P<0.01).Conclusion It is of prime importance to ensure optimal ventilation in the early stage of diseases,the difficulty and risk of establishment of a patent airway are main problems in the treatment of critically ill patients.