双水平气道正压通气治疗重症哮喘患者的临床研究

目的 探讨重症哮喘应用双水平气道正压通气的临床疗效。方法 将32例重症支气管哮喘患者,随机分为两组,即药物治疗组（对照组）和无创通气＋药物治疗组（实验组）,每组各16例,早期采用无创正压通气模式,使用鼻（面）罩式双相气道正压呼吸机,比较两组实施双水平正压通气治疗前、治疗6h及3d后动脉血气中的pH、PaCO2、PaO2、SaO2变化以及监测心率（HR）、呼吸频率（RR）、平均动脉血压（ABPM）和最高峰流速（PEF）的改变。结果 实验组血气指标（PaO2、PaCO2、pH、SaO2）以及监测ABPM、RR、HR和PEF的改善均优于对照组（P〈0.01）。结论 双水平正压通气是治疗重症哮喘的有效方法之一。但对无创正压通气治疗后病情继续恶化的患者应及时改为气管插管行有创通气。

Clinical research of bi-level positive airway pressure ventilation in treatment of severe asthma patients

Objective To exam the clinical value of bi-level positive airway pressure(BiPAP) ventilation in treatment of severe asthma patients.Methods Thirty-two cases of severe asthma were randomly divided into two groups.One group was treated by drugs(control group),the other group were treated by noninvasive positive pressure ventilation(NPPV) and the drugs(experiment group) with 16 cases in each group.The experiment group was treated with BiPAP ventilation via facial(nasal) mask.The comparison was made on the changes of pH,PaO2,PaCO2,SaO2 in the arterial blood gas before and after the trement between two groups.And also the changes of heart rate(HR) and respiratory rate(RR) and ABPM,PEF were obtained before treatment,after 6 hours,and 3 days between two groups.Results Significant differences were found in the experiment group of the improvement of PaO2 and PaCO2 and SaO2 and PEF and ABPM,compared with those of the control group(P<0.01).Conclusions Non-invasive BiPAP ventilation was one of the effective methods to cure the asthma patients.However,NPPV should be transformed into endotracheal intubation and invasive positive pressure ventilation immediately when the clinical condition deteriorates in the patients with severe asthma.