机械通气治疗重型颅脑损伤合并呼吸衰竭146例临床分析

目的研究机械通气治疗重型颅脑损伤合并呼吸衰竭的临床效果及呼吸机相关性肺炎（VAP）的防治。方法采用SIMV或CPAP模式＋PSV、PEEP机械通气治疗重型颅脑损伤合并呼吸衰竭146例,治疗组73例,规范治疗＋防御性人工气道措施＋通便、胃肠调理与早期肠道营养;对照组73例,规范治疗。结果治疗组VAP发生率明显低于对照组,受损神经功能恢复程度和生存质量明显优于对照组,差异有统计学意义（P〈0.05）。结论在积极规范治疗原发病同时,及早气管插管或气管切开进行机械通气,积极防治呼吸机相关性肺炎（VAP）,配合防御性人工气道措施＋通便、胃肠调理与早期肠道营养治疗,可以降低重型颅脑损伤合并呼吸衰竭患者VAP,提高抢救成功率并改善其预后。

Clinical analysis of mechanical ventilation in treat ment of severe craniocerebral injury with respiratory failure in 146 cases

Objective To study the mechanical ventilation for treatment of severe craniocerebral injury with respiratory failure and prevention and control of ventilator associated pneumonia （VAP）. Methods adopting the model of CPAP or SIMV ＋ PSV PEEP ,mechanical ventilation treatment of severe craniocerebral injury with respiratory failure of 146 cases were curde,in treatment group 73 cases,standard treatment ＋ artificial airway defensive measures,purge,gastrointestinal nursing and early enteral nutrition; Control group 73 cases, the standard treatment. Results The VAP incidence of treatment group was obviously lower than the control group,the degree of damaged nerve functional recovery and survival quality was better than control group,the difference was statistically significant （P 0.05）. Conclusion Norms in active treatment the primary disease at the same time , the early endotracheal intubation or tracheotomy with mechanical ventilation,active prevention and treatment of ventilator associated pneumonia （VAP）,artificial airway with defensive measures ＋ purge ,gastrointestinal nursing and early enteral nutrition therapy,can reduce severe craniocerebral injury with respiratory failure in patients with VAP, and improve the rescue success rate and to improve its prognosis.