无创正压通气辅助治疗急性辐射性肺炎并发呼吸衰竭19例观察

目的:探讨无创正压机械通气(NIPPV)在急性放射性肺炎伴呼吸衰竭治疗中的临床应用价值。方法:对19例急性放射性肺炎伴呼吸衰竭患者采用经口鼻面罩双水平正压通气,呼吸机模式设置为S/T,吸气峰压初始为6~8cmH2O,渐升至10~22cmH2O,平均13.9±5.6 cmH2O;呼气末压力为3~7cmH2O,平均4.5±0.7cmH2O,吸氧浓度(FIO2)>37%,维持血氧饱和度在90%以上。根据观察动脉血气分析,临床体征及症状进行疗效评估,NIPPV无效者改为有创通气。结果:NIPPV治疗后心率、呼吸频率、SpO2、PO2值与治疗前比较有显著性差异(P<0.05或P<0.01)。19例患者中15例临床症状明显好转,有效率79%。结论:急性放射性肺炎并发呼吸衰竭患者在药物治疗基础上,实施无创正压通气能有效纠正低氧血症,减少对免疫功能低下肿瘤患者的有创操作,对损伤肺的保护性治疗有积极作用。

Noninvasive positive pressure ventilation therapy in acute radiation pneumonitis with respiratory failure

Objective: To explore clinical value of the assistance of NIPPV on acute radiation pneumonitis patients with respiratory failure.Methods: 19 patients were treated with BiPAP ventilation via face mask: mode S/T,inspiratory peak airway pressure 6~ 8cmH2O to 10~22cmH2O(13.9 ±5.6) and end expiratory peak airway pressure 3~7cmH2O(4.5±0.7),FIO2>37% SpO2>90%.Invasive positive pressure ventilation were delivered when NIPPV failed.Benefits of NIPPV were evaluated based on the improvement of clinical symptoms and artery blood gas analysis.Results: HR,R,SpO2,PO2,were improved significantly after NIPPV(P< 0.05 or P< 0.01).15 cases(79%) got benefit from the treatment.Conclusion: NIPPV seems ideal for the treatment of acute radiation pneumonitis with respiratory failure,which allows adequate oxygenation and ventilation to be maintained without causing further damage to the already injured lung.It is also a sound strategy for preventing ventilator-associated infection in patients with depression in immunological function.