无创正压通气治疗急性河豚鱼中毒合并呼吸衰竭的疗效观察

目的：探讨无创正压机械通气（NIPPV）治疗急性河豚鱼中毒合并呼吸衰竭的疗效。方法选择21例急性河豚鱼中毒合并呼吸衰竭的患者，观察治疗前后动脉血酸碱度（pH）、动脉氧分压（PaO2）、动脉二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）以及呼吸频率（RR）、心率（HR）、血压（BP）和辅助呼吸机动用评分（ARMES）等。结果 NIPPV治疗急性河豚鱼中毒合并呼吸衰竭的患者6 h后pH、PaO2、SaO2、RR、HR、BP、ARMES均明显优于治疗前（P＜0.01），治疗24 h后可明显降低PaCO2（P＜0.05）。3例患者行有创机械通气治疗，其中2例5 d后顺利脱机，1例经抢救无效死亡。结论急性河豚鱼中毒所致呼吸衰竭具有可逆性、时间性的特点，NIPPV通过提高PaO2、降低PaCO2，迅速缓解呼吸困难、改善呼吸肌疲劳，降低气管插管率和病死率，对于急性河豚鱼中毒合并呼吸衰竭是一种切实有效的治疗措施。

Effect of noninvasive positive pressure ventilation in the treatment of acute puffer fish poisoning combined with respiratory failure

Objective To investigate the effect of noninvasive positive pressure ventilation （NIPPV）in the treatment of acute puffer fish poisoning combined with respiratory failure. Methods Twenty-one patients suffered from acute puffer fish poisoning combined with respiratory failure were selected. Arterial blood pH, PaO2, PaCO2, oxyhemo-globin saturation （SaO2）, respiratory rate （RR）, heart rate （HR）, blood pressure （BP） and accessory respiratory muscle em-ploy score （ARMES） in these patients were observed and recorded before and after the treatment. Results 6 hours after the treatment of NIPPV in the patients suffering from acute puffer fish poisoning combined with respiratory failure, the pH, PaO2, SaO2, RR, HR, BP and ARMES were significantly improved compared with that before the treatment （P〈0.01）. PaCO2 decreased significantly 24 hours after the treatment （P〈0.05）. 3 patients underwent invasive mechanical ventilation treatment, two of whom successfully weaned from the ventilator 5 days later and one died. Conclusion Re-spiratory failure caused by acute puffer fish poisoning is reversible. Noninvasive positive pressure ventilation can quick-ly relieve dyspnea, improve respiratory muscle fatigue and reduce intubation rate and mortality by increasing PaO2 and decreasing PaCO2. It is an effective treatment for acute puffer fish poisoning combined with respiratory failure.