早期无创正压通气对SARS病人氧合功能影响

为总结对严重急性呼吸综合征(SARS)合并呼吸功能不全病人使用无创正压通气(NIPPV)治疗的经验与体会,评价其在早期对SARS病人呼吸功能改善的作用,收集并比较因呼吸功能不全而使用持续无创双相正压面罩通气(BiPAP)治疗的25例SARS病人,治疗前与治疗24h内相关呼吸参数和生理指标的变化,初步分析NIPPV早期对SARS病人氧合功能影响。结果NIPPV后24h内多数病人的气促和呼吸困难有不同程度缓解,心率(HR)和呼吸频率(RR)明显减慢,脉搏血氧饱和度(SpO2)和氧合水平用改良呼吸指数(MRI)显著升高(P<0.05)。提示NIPPV早期应用对SARS合并呼吸功能不全病人的氧合功能有明显的改善作用。

Early Effects of Noninvasive Positive Pressure Ventilation on Oxygenation of SARS Patients with Acute Respiratory Failure

The objective was to summarize and analyze our experience in the noninvasive positive pressure ventilation(NIPPV)therapy for the acute respiratory insufficiency patients due to severe acute respiratory syndrome(SARS),and to evaluate the effects of NIPPV on treatment for SARS.25cases of SARS with acute lung injury on NIPPV were studied restrospectively in order to investigate the implications of NIPPV in improving oxygenation according to collectable relevant physical findings and laboratory measurements documented before and within24h after initiation of support.NIPPV was an effective treatment in ameliorating dyspnea or tachypnea and tachycardia,decreasing the amount of spontaneous work of breathing and correcting the rapid shallow breathing,decreasing heart rate(HR)and respiratory rate(RR)(P<0.05),and increasing saturation of oxygen(SpO 2 )and modificative respiratory index(MRI)(P<0.05)for the majority of SARS patients with acute respiratory dysfunction within24h after initiation of therapy.NIPPV can be considered as a valid therapeutic option in short-term stage for SARS patients with hypoxemia,and it also should be considered as first-line intervention in the early phases of SARS with acute respiratory insufficiency before eventual endotracheal intubation.The conventional use of NIPPV in SARS patients with hypoxaemic acute respiratory failure still remains controversial,however.The application of noninvasive positive pressure ventilation may be an effective treatment in correcting gas exchange abnormalities,relieving respiratory distress and,perhaps,avoiding or decreasing the need for endotracheal intubation in selected patients with acute respiratory insufficiency secondary to SARS.