山莨菪碱和无创面罩正压通气治疗急性呼吸窘迫综合征的临床观察

目的比较山莨菪碱联合无创正压面罩通气（654-2＋NIPPV）和传统机械通气（CMV）治疗急性呼吸窘迫综合征（ARDS）的临床效果，评估山莨菪碱联合无创正压通气在ARDS治疗中的作用。方法将各种原因所致ARDS患者42例随机分为654-2＋NIPPV组（21例）和CMV组（21例），在给予病因治疗同时分别实施654-2＋NIPPV和CMV。观察分析两组患者在治疗过程中动脉血气变化、并发症的发生率及治疗效果。结果654-2＋NIPPV组有8例（38．1％）治疗失败转为气管插管实行CMV，其中6例（28．6％）死亡。CMV组死亡7例（33．3％），两组病死率无显著差异（P〉0.05）。两组治疗有效的患者在分别接受654-2＋NIPPV和CMV治疗后1h和6h动脉血气有相似的显著改善。654-2＋NIPPV组患者机械通气时间和住院时间短于CMV组（P〈0.05）。654-2＋NIPPV组的并发症发生率低于CMV组（P〈0.05）。结论在经过选择的ARDS患者中，应用654-2＋NIPPV治疗的临床效果与CMV相似。实施654-2＋NIPPV可缩短机械通气和住院时间，减少并发症。654-2＋NIPPV可作为经过选择的ARDS患者首选的通气支持治疗手段。

Treatment of Acute Respiratory Distress Syndrome with Anisodamine and Noninvasive Positive Pressure Ventilation

Objective To compare the treatment efficacy of Anisodamine(654-2) combined with noninvasive positive pressure ventilation(654-2+NIPPV) with that of conventional mechanical ventilation(CMV) in patients with acute respiratory distress syndrome(ARDS) and evaluate the effect of 654-2+NIPPV on the treatment of ARDS.Methods Forty-two patients with ARDS caused by various disorders were randomly divided into 654-2+NIPPV group(21 cases) and CMV group(21cases).Patients in two groups were treated by 654-2+NIPPV through a facemask or CMV with endotracheal intubation respectively when disorders causing ARDS managed by medical therapy.Arterial blood gases were analyzed,and the rate of complication and outcome were observed.Results In 654-2+NIPPV group,8 patients were transformed into CMV for worsening condition and arterial blood gases.Mortality rate in 654-2+NIPPV group(28.6%) was similar to CMV group(33.3%)(P>0.05).After 1 hour and 6 hours of ventilation,artery blood gas of patients of both two groups improved significantly and similarly. Duration of mechanical ventilation and hospital stay for patients receiving 654-2+NIPPV were significantly shorter than those in patients receiving CMV(P<0.05).The complication rate in 654-2+NIPPV group was markedly lower than that in CMV group(<0.05).Conclusion Clinical efficacy of 654-2+NIPPV was similar to CMV in selected patients with ARDS.Use of 654-2+NIPPV in patients with ARDS might reduce duration of mechanical ventilation and hospital stay,and decrease rate of complication.654-2+NIPPV might be the ventilatory support therapy of the first choice for the selected patients with ARDS.