无创通气在胸部创伤急性呼吸衰竭撤机的临床应用

目的探讨无创的双水平正压通气（bilevel positive airway pressure BiPAP）在胸部创伤合并急性呼吸衰竭在撤机时的运用。方法将本院1999年1月～2006年1月胸部创伤合并急性呼吸衰竭的43例患者，抢救开始时用间歇正压通气模式，患者病情一旦进入稳定期，22例采用无创正压通气BiPAP模式作为撤机模式为治疗组。另外严格在同一时期随机选出21例同样病情的患者采用的SIMV＋PSV机械通气模式撤机作为对照组。比较两组的ICU住院时间，呼吸机相关的并发症，病死率。结果治疗组中在ICU中治疗时间比对照组明显缩短，呼吸机相关的并发症，病死率少于对照组。结论在胸部创伤合并急性呼吸衰竭的患者治疗中，首先用有创的间歇正压通气抢救，保证患者氧合，然后选择时机改用双水平正压通气，疗效确切，优于传统方法。

Clinical Application for Non-invasive MechanicalVentilation in Weaning Mechanical Ventilation for Thoracic Injury Induced Acute Respiratory Failure

Objective To explore the therapeutical effect of bilevel positive airway pressure(BiPAP) in thoracic injury induced acute severe respiratory failure when patients will wean mechanical ventilation.Method 43 patients with thoracic injury induced acute respiratory failure were managed from Jan 1999 to Jan 2006.The clinical data were retrospectively analyzed.IPPV was the earliest treatment for acute respiratory failure.22 patients(study group) were treated with BiPAP when the time was reasonable.Other 21 patients(control group)whom were selected randomly with similar clinical characteristics were continuously received IPPV.Major complications,time of intensive care unit(ICU) stay and mortality were compared in the two groups.Results The incidence of complications,time of ICU stay and mortality in study group were fewer than those in control group.Conclusion Sequential non-invasive following invasive mechanical ventilation in thoracic injury induced acute respiratory failure can prove clinical effect.It is superior to conventional therapy,which is worth spreading clinically.