双相气道正压通气治疗神经肌肉疾病出现急性呼吸衰竭的临床疗效

目的　探讨双相气道正压 (BIPAP)通气模式治疗神经肌肉疾病出现急性呼吸衰竭的疗效。方法　 3 6例神经肌肉疾病出现急性呼吸衰竭的患者随机分为采用双相气道正压 (BIPAP)通气模式的BIPAP组和采用压力支持通气 (PSV)模式的PSV组 ,每组各 18例。观察机械通气期间患者镇静剂地西泮 (安定 )的用量 ,气道力学参数中的吸气峰压 (PIP)、平台压 (Pplate)和呼气末正压 (PEEP)的变化 ,机械通气的时间及撤机的成功率。结果　 3 6例均在对原发病治疗的基础上 ,BIPAP组通气时间 (d) 13 .2± 7.4与PSV组 14 .6± 6.2比较差异无显著性(P >0 .0 5 )。BIPAP组地西泮的用量 ,PIP ,Pplate和PEEP均显著低于PSV组 (P <0 .0 5 )。BIPAP组撤机成功例次高于PSV组 (P <0 .0 5 )。 3 6例中 2 9例治愈出院 ,7例死亡 ,出现与机械通气有关的并发症 2 1例。结论　BIPAP通气模式在治疗神经肌肉疾病出现急性呼吸衰竭时人机关系协同性好 ,且撤机成功率高

Clinical Efficacy of Biphasic Positive Airway Pressure Ventilation for Patients with Acute Respiratory Failure in Neuromuscular Disorders

Objective To evaluate the effect of biphasic positive airway pressure (BIPAP) ventilation mode on acute respiratory failure in neuromuscular disorders and compare it with pressure support ventilation (PSV). Methods Thirty-six cases with acute respiratory failure resulting from neuromuscular disorders were at random divided into a BIPAP group and a PSV group (18 cases per group). The dosage of diazepam, the change of peak inspiratory pressure (PIP), plateau pressure (Pplate), and positive end expiratory pressure (PEEP) were observed during mechanical ventilation. The successful rate of weaning was monitored. Results No significant difference was found in the total duration of mechanical ventilation between the two groups. The dosage of diazepam, PIP, Pplate and PEEP were significantly lower in the BIPAP group than in the PSV group during mechanial ventilation (P>0.05 ). The successful rate of weaning was significantly higher in the BIPAP group than in the PSV group (P>0.05 ). Twenty-nine cases were discharged from the hospital. Complications occurred in 21 cases during mechanical ventilation. Conclusion BIPAP is an effective mode of mechanical ventilation therapy for the patients with acute respiratory failure in neuromuscular disorder, for it can increase the successful fate of weaning.