无创-有创-无创序贯性机械通气治疗危重哮喘36例

目的观察序贯性机械通气在危重支气管哮喘患者的应用价值。方法选择危重支气管哮喘患者72例,随机分为序贯治疗组和对照组,每组36例,在内科综合治疗基础上,序贯治疗组依次选择BiPAP→A/C→SIMV或SIMV＋PSV→BiPAP或PSV＋PEEP通气模式,而对照组选择A/C→SIMV通气模式。结果序贯治疗组有创通气时间、总机械通气时间、发生呼吸机相关性肺炎（VAP）、撤机失败、住院时间与对照组比较差异均有统计学意义（P〈0.05）。结论危重支气管哮喘患者采用无创-有创-无创性序贯通气是治疗危重支气管哮喘行之有效的手段，能明显缩短有创通气时间，降低VAP发生率，减少撤机失败，缩短住院时间，降低病死率。

Application Value of Sequential Mechanical Ventilation for Critical Bronchialasthma:a Report of 36 Cases

Objective To observe the application value of sequential mechanical ventilation in the treatment of critical bronchialasthma.Methods 72 cases of serious bronchialasthma were randomly divided into sequential therapy group and the control group（36 cases in each group）.The sequential therapy group chose BiPAP→A/C→SIMV or SIMV＋PSV→BiPAP or PSV＋PEEP ventilation,and the control group chose A/C→SIMV ventilation.Results The differences in invasive ventilation time,the total duration of mechanical ventilation,venti1ator-associated pneumonia（VAP）,weaning failure,the length of hospitalization and mortality between sequential treatment group and the control group had statistical significance（P0.05）.Conclusion Noninvasive-invasive-noninvasive ventilation is effective treatment for patients with critical bronchialasthma.it can significantly shorten the time of invasive ventilation,the length of hospitalization and reduce the incidence of VAP,weaning failure and the mortality.