有创-无创序贯通气治疗急性有机磷中毒致中间期肌无力综合征

目的采用双水平气道正压通气(BiPAP)呼吸机经口/鼻罩正压通气,探讨在急性重度有机磷中毒(AOPP)致中间期肌无力综合征(IMS)有创机械通气后脱机过渡中的应用价值,并与传统方法比较。方法AOPP致IMS患者25例,均行有创机械通气,出现IMS控制窗后,分为常规治疗组(10例)和序贯治疗组(15例)。检测两组患者心肌酶学变化,上BiPAP呼吸机前、2h后测动脉血气,监测HR、BP、SpO2,并计算重新气管插管率。结果两组治疗后心肌酶(CK、CK-MB、AST、LDH)较治疗前均明显下降,有显著差异(P<0·01);序贯治疗组患者拔管前及拔管2h后生命体征及动脉血气分析比较差异无显著性(P>0·05);撤机后序贯治疗组在有创通气时间、总机械通气时间、住ICU/EICU时间明显缩短(P<0·05);VAP的发生率两组相似;序贯治疗组重新气管插管率明显低于对照组(P<0·05)。结论患者对BiPAP呼吸机耐受性好,能够改善AOPP致IMS的通气功能,并能使常规机械通气顺利脱机,减少重新插管率。

Sequential invasive-noninvasive mechanical ventilation in intermediate myasthenia syndrome due to acute organphosphorus pesticides poisoning

Objective To investigate the changes in acute organphosphorus pesticides poisoning(AOPP) with intermediated myasthenia syndrome(IMS) patients during sequential invasive-noninvasive mechanical ventilation therapy,and evaluate the effects of this new technique.Methods 25 AOPP patients with IMS were ventilated through an endotracheal tube.When the IMS window occurred,the patients were divided into two groups randomly:traditional group (10 cases)and BiPAP group (15 cases).The parameters of hemodynamics,oxygen dynamics were measured at the PIC-Window during invasive mechanical ventilation,two hours after oxygen therapy,after non-invasive mechanical ventilation,and the reintubation rate was calculated.The traditional group was treated with conventional therapy alone.Results There were no difference in clinical characteristics and gas exchange at entry.The myocardial creatase including CK,CK-MB,AST,LDH were decreased,compared with pretreatment(P<0.05).There were no significant differences in respiratory and circulatory parameters after treatment in BiPAP group(P>0.05).Compared with the traditional group,the time of invasive mechanical ventilation,total time of ventilatory assistance and hospitalized time in ICU/EICU were decreased markedly(P<0.05),and the incidence of ventilator associated pneumonia (VAP)was similar in two groups.Reintubation rate was higher in the traditional group(P<0.05).Conclusions The IMS patients can tolerate the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.BiPAP can improve ventilation function,and reduce the reintubation rate in regular mechanical ventilation.