甲型H1N1流感危重症患者机械通气导致气胸的防治体会

目的探讨我市甲型H1N1流感危重患者因机械通气导致气胸的救治策略及预后相关因素。方法根据卫生部《甲型H1N1流感诊疗方案（2009年试行版第三版）》的诊断标准,我市2009年11月21日～2010年2月1日期间共收治了7例甲型H1N1流感危重患者,分析其临床特点与气胸的关系,机械通气模式与气胸的关系。结果 7例危重患者中有3例发生气胸（1例为孕妇）。气胸患者从就诊至由咽拭子确诊时间大于未发生者（P〈0.05）,入院时脉搏氧饱和度（SpO2）小于未发生者（P〈0.05）,本组气胸患者在入院时神志昏迷（P〈0.05）。在开始通气这段时间,气胸发生组患者的通气效果有好于未发生气胸组的趋势。结论本研究发现由于甲流病毒导致的肺损伤,导致机械通气患者的气胸发生率远高于其他疾病导致的ARDS,在有创机械通气期间,降低潮气量并不能促使气胸早日治愈,仍会存在持续漏气现象,只有当肺功能改善,脱离呼吸机后,肺漏气现象才可改善。

The experience of prevention and treatment of pneumothorax caused by severe pandemic H1N1 influenza during mechanical ventilation

Objective To discuss the treatment strategy of pneumothorax caused by severe pandemic H1N1 influenza during mechanical ventilation,and to discuss the factors related to the prognosis.MethodsThe patients was included according to the Chinese Natinonal diagnostic criteria,and the clinical features and ventilation mode was analysed.ResultsFrom November 2009 to February 2010,7 patients suffered severe pandemic H1N1 influenza were analysised,and among which 3 happened pneurnothorax（one was pregnant woman who was cured successed）.For the patients suffered pneumothorax;the time from admission to definitely diagnosed was longer（P0.05）,the SpO2 was much lower（P 0.05）,and were coma on admission（P 0.05）.And there was a trend that the pneumothorax group got a better ventilation effect.Conclusion The patients got severe pandemic H1N1 influenza had a higher risk of pneumothorax than other ARDS caused by other factors.And during the ventilation,it′s useless to reduce the tidal volume,the air leak continued unless the mechanical ventilation was weaned.