无创正压通气治疗重症免疫抑制相关性肺病28例

目的探讨无创正压通气对重症免疫抑制相关性肺病患者并发急性呼吸衰竭的治疗效果。方法28例患者除给予常规治疗外，使用呼吸机给予无创正压通气，选用压力支持通气模式（PSV），自主呼吸减弱时则改为SIMV＋PSV模式。结果18例患者完成治疗，10例失败，其中6例改用有创通气治疗。18例治疗成功病例的通气时间平均为15．8±8．4天，其动脉血气分析指标、呼吸频率、心率均较通气前明显改善（P〈0．05），治疗成功与失败的病例在APACHEⅡ评分，不耐受，气胸方面比较，差异有显著性（P〈0．05）。结论经面罩无创通气治疗免疫抑制患者并发严重呼吸衰竭效果肯定，但应严格掌握适应症，尽量避免并发症。

Noninvasive Positive Pressure Ventilation in Twenty-eight Patients With Severe Immunocompromised Lung Diseases

Objective To evaluate the efficacy of noninvasive positive pressure ventilation in patients with severe immunocompromised lung diseases with acute respiratory failure. Methods Twenty eight patients were treated with conventional treatment plus noninvasive positive pressure ventilation,the mode of ventilation was PSV, or SIMV ＋ PSV with the presence of weakened spontaneous breath. Results With an average treating time of（ 15.8 ± 8.4） days,the treatment was suc- cessful in eighteen patients, outcomes of arterial blood gas analysis, breath, and heart beat rates were greatly improved;the patients were discharged well（ P 〈 0.05 ） ; while invasive eventilation was supplemented to other 6 patients. Significant differences in the intolerance, pneumatothorax and APACHEII scores were presented between the eighteen successful cases and the 6 failed ones. Conclusions Noninvasive mechanical ventilation shows good effects on patients with severe immunocompromised lung diseases with acute respiratory failure ,but should be strictly applied and complications should be avoided.