8例严重急性呼吸综合征患者有创机械通气治疗总结

为探讨严重急性呼吸综合征(severeacuterespiratorysyndrome,SARS)进行有创机械通气的治疗策略,在常规治疗和无创通气失败后,对8例重症SARS患者[男5例,女3例,年龄30～74岁,平均(55±16)岁]施行经气管切开插管进行有创机械通气,采用压力控制通气模式,监测通气前后的生命体征和血气分析,并对通气过程中的并发症和患者的转归进行分析。结果1)8例患者均高热(体温>38.5℃),7例患者的外周血白细胞总数在正常范围,仅1例高于正常。合并其他脏器损害7例。2)从发病到使用气管切开机械通气的时间平均为(27.9±12.2)d,有创机械通气使用时间平均为(8.6±5.4)d,机械通气模式为压力控制或压力调节加呼气末正压通气。行有创通气后动脉血氧饱和度(SaO2)较通气前改善(P<0.01)。3)有创通气前1例出现气胸,有创通气时2例出现纵隔气肿及气胸。4)1例患者撤机并痊愈,7例死亡,死亡患者多合并严重基础疾病。提示有创机械通气对于晚期重症SARS疗效不佳。通气模式应选择压力控制通气模式和合适的呼气末压力水平,尽量减少机械通气相关肺损伤。

Mechanical Ventilation in Treatment of Severe Acute Respiratory Syndrome

The objective was to study a strategy of mechanical ventilation for patients with critically severe acute respiratory syndrome(SARS).Eight patients with critical SARS(5males and3females),aged from30to74years〔mean age(55±16)yrs〕,were enrolled in the study.After failure in routine treatment and non-invasive ventilation initiatively,all patients received tracheotomy for intermittent positive pressure ventilation.The vital sign,blood gas analysis and the oxygenation function were observed before and after ventilation.The complications and prognosis were evaluated.Results:1)All eight patients had high fever(T>38.5℃),seven showed normal white blood cell counts,and seven had dysfunction of other organs.2)The average time from onset to invasion ventilation was(27.9±12.2)d and the average time of invasion ventilation was(8.6±5.4)d.All patients used pressure controlled ventilation or pressure support ventilation plus positive expiratory end pressure(PCV/PSV+PEEP).After invasive ventilation SaO₂ increased(P<0.01).3)One patient had pneumothorax before ventilation.Bilateral pneumothorax and pneumomediastinum occurred in two patient during ventilation.4)One patient recovered after the application of mechanical ventilation.Seven patients died of severe diseases and complications.The application of mechanical ventilation in patients interminal stages of critical SARS has no obvious effect.The oxygenation and lung injury may be improved by PCV and appropriate PEEP.