早期无创正压通气治疗连枷胸合并急性肺损伤疗效观察

目的探讨无创正压通气在连枷胸合并急性肺损伤中的疗效。方法随机选择42例符合ALI标准连枷胸合并肺挫伤患者并分为两组，一组早期使用无创正压通气，对照组为早期面罩吸氧。比较两组间发展到ARDS的例数、呼吸机通气天数、气管插管例数，以及治疗48h的呼吸频率、心率、动脉血氧分压和氧合指数。结果早期无创正压通气组相对对照组在发展到ARDS例数、呼吸机通气天数、气管插管数及48h后呼吸频率、心率、动脉血氧分压、氧合指数改善优于对照组，差异有统计学意义（P〈0．05）。结论急性肺损伤是连枷胸合并肺挫伤低氧血症早期阶段，大部分会发展到ARDS，早期无创正压通气治疗可以明显逆转此进程，连枷胸合并肺挫伤的患者一旦有急性肺损伤应尽早实施无创正压通气。

Observation on the Teatment of NIPPV in Flail Chest Together with Acute Lung Injury

Objective To discuss the effect of noninvasive positive pressure ventilation （NIPPV） used in flail chest with acute lung injury（ALI）. Method 42 patients suffered from flail chest with ALI were divided into two groups at random and carried out NIPPV on one group while another mask oxygen. Compared the two groups by the number of cases that developed to ARDS, ventilator days, intubation and bresthing rate, heart rate, arterial partial pressure of oxygen and oxygenation index after treated for 48 hours. Results The group performed by NIPPV in an early stage had significant differences compared with the control group in the number of the patients that developed to ARDS, ventilator days, intubation and bresthing rate, heart rate, arterial partial pressure of oxygen and oxygenation index after treated for 48 hours（P〈0.05）, and it is superior to the latter. Conclusion ALI is the early stage of flail chest with contusion of lung, most will develop to ARDS, early NIPPV will reverse its process obviously. NIPPV should be performed on the patients who suffer from flail chest with contusion of lung as early as possible when acute lung injury occurs.