机械通气救治重症支气管哮喘28例临床分析

目的探讨重症支气管哮喘应用机械通气的治疗效果。方法我院于2007年1月至2011年1月对重症哮喘患者行机械通气28例。采用无创正压通气和(或)有创机械通气,并尽早撤机。结果 28例患者中15例患者为经口气管插管,应用BiPAP呼吸机13例,为面罩机械通气,平均上机4h后呼吸困难症状均不同程度减轻,发绀亦消退,神志转清,双肺哮鸣音减少。24h内症状明显得到缓解,高碳酸血症和低氧血症迅速改善,5～7d脱离呼吸机。27例患者抢救成功,1例患者因多脏器功能衰竭而死亡。机械通气时间为24～144h,平均(60±17)h。1例发生呼吸机相关肺炎,1例发生气压伤。结论应用机械通气治疗重症哮喘,可提高抢救成功率高,是抢救重症哮喘的一种有效的方法。

Clinical analysis on mechanical ventilation in the treatment of 28 cases of severe bronchial asthma

Objective To investigate the clinical effect of mechanical ventilation in the treatment of severe bronchial asthma.Methods Twenty-eight patients with severe bronchial asthma were treated with mechanical ventilation in our hospital from January 2007 to January 2011.Non-invasive positive pressure ventilation and invasive mechanical ventilation were applied,and mechanical ventilation time was minimized.Results Among the 28 patients,15 patients received orotracheal intubation,and 13 patients received face mask mechanical ventilation therapy applying BiPAP respirator.Symptoms were lessened after treated for 4 h in mean,with subsided cyanosis,consciousness recovery,and reduced double pulmonary wheeze.Within 24 hours,the symptoms were alleviated significantly,hypoxia and carbonic acid retention were improved rapidly.Patients were off the ventilator in 5~7 days.Of the 28 patients,27 were successfully rescued,while one died of multiple organ failure.The duration of mechanical ventilation was 24~144 h,(60±17) h in average.One patient underwent ventilator associated pneumonia and one underwent pressure lung injury.Conclusion Mechanical ventilation is an effective way to modify symptoms and rescue patients with severe bronchial asthma.