无创正压通气治疗急性呼吸窘迫综合征的研究

目的：探讨无创正压通气(NIPPV)治疗急性呼吸窘迫综合征(ARDS)改善疗效的因素。方法：23例ARDS患者按诱发因素分为肺内因素组(A组)和肺外因素组(B组)。选择不同呼吸机和鼻(面)罩行NIPPV，采用双相压力支持通气(BiPAP)；多功能呼吸机采用压力支持通气(PSV) 呼气末正压(PEEP)或同步间歇指令通气(SIMV) PSV PEEP。通气3—10h，不适合NIPPV的患者改建人工气道通气。结果：全程进行NIPPV治疗的患者A组5例，B组12例；NIPPV治愈A组为55．6％(5／9)；B组为85．7％(12／14)，P＜0．05。结论：选择合适的适应证，合理选择呼吸机、呼吸模式和治疗参数，并改善对NIPPV不利的影响因素，可以减少人工气道的使用。

Effect of noninvasive positive pressure ventilation on treatment of acute respiratory distress syndrome

Objective: To investigate the factors affecting the effect of noninvasive positive pressure ventilation(NIPPV) on treatment of acute respiratory distress syndrome(ARDS). Methods: According to the diseaseinduced factors, patients with ARDS were divided into two groups: group A( pulmonary factors ), group B(extrapulmonary factors). Different kinds of ventilators were used in the course of NIPPV via facial or nasal mask. The mode, biphasic intermittent positive airway pressure(BiPAP, BiPAP vision), pressure surpport ventilation(PSV)+positive end expiratory pressure(PEEP) or synchronized intermittent mandatory ventilation(SIMV)+PSV+PEEP, was administered. After 310 hours, the patients who were not fit to NIPPV were conducted intubation. Results: Group A had 9 cases, of whom 5 cases were treated with NIPPV all the time, while in group B, 14 cases, of whom 12 cases The cure rate of group A by NIPPV was 55 6%(5/9), while that of group B was 85 7%(12/14), P <0 05. Conclusion: Selecting proper indication, reasonable ventilator mode and parameters, and improving the unfavorable factors can contribute to the decrease of intubation rate.