序贯性机械通气治疗有机磷农药中毒中间综合征

目的探讨有创与无创序贯性机械通气在急性有机磷中毒（AOPP）致中间期肌无力综合征（IMS）中的应用价值，并与传统方法比较。方法AOPP致IMS患者22例，均行有创机械通气，出现IMS控制窗后，随机分为常规治疗组（11例）和序贯治疗组（11例）。检测2组患者使用BiPAP呼吸机前、后2h测动脉血气，监测心率、血压、血氧饱和度，并计算重新气管插管率。结果序贯治疗组患者拔管前及拔管后2h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EICU时间明显缩短（P〈0．05）；呼吸机相关性肺炎（VAP）的发生率2组相似；序贯治疗组重新气管插管率明显低于常规组（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 mechanical ventilation in AOPP with intermediate myasthenia syndrome

Objective To investigate the changes in the patints with acute organophosphorus pesticides poisoning (AOPP) and intermediate myasthenia syndrome(IMS) under the sequential mechanical ventilation therapy,and to evaluate the effects of this new technique.Methods 22 AOPP patients with IMS were ventilated via endotracheal tube.When the IMS window appeared,the patients were divided into two groups randomly to continue the treatment: traditional group(11cases) and non-invasive BiPAP group(11cases).The parameters of hemodynamics and blood gases were monitored through the course,with the rate of reintubation noted.Results There were no significant differences in respiratory and circulatory parameters before and 2h after the use of BiPAP non-invasive ventilation(P>0.05).Compared with those in the traditional group,the time of invasive mechanical ventilation,total time of ventilatory assistance and the length of stay in EICU were decreased markedly(P<0.05).The incidence of ventilator associated pneumonia(VAP) was similar in the two groups.The reintubation rate was higher in the traditional group(P<0.05).Conclusions The IMS patients can well tolerate the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.BiPAP can improve ventilation in the patients with AOPP induced IMS and reduce the rate of reintubation.