允许性高碳酸血症联用低呼气末正压通气在危重哮喘中的应用

目的 探讨允许性高碳酸的血症（ＰＨＶ）联用低呼气末正压（ＰＥＥＰ）通气治疗危重哮喘的效果。方法 １２例危重哮喘患者采用容量控制或辅助／控制模式并采用ＰＨＶ通气策略（ＰａＣＯ２〈１０．６ｋＰａ，ｐＨ〉７．１５）。２例患者采用ＳＩＭＶ和ＰＥＥＰ，潮气量设定６～８ｍｌ／ｋｇ，ＰＥＥＰ设在５～１０ｃｍＨ２Ｏ压力左右。呼吸频率为１４～１６次／ｍｉｎ。同时记录吸入氧浓度（ＦｉＯ２）、气道峰压（ＰＩＰ）、动脉血

Application of permissive hypercapnia ventilation combined with iow positive-end-expiratory-pressure in the treat-ment of severe asthma

Objectives To investigate the effectiveness of PHV combined with low PEEP for severe asthma.Methods 12 severe asthma patients were treated with PHV combined with low PEEP ventilation. Ventilation modewas set as volume control or assistant/control with PHV (PaCO2＜10.6 kPa,pH＞7.15). 2 of them were treated withSIMV and PEEP. The tidal volume was set as 6 8 mi/kg. PEEP was set at 5～10 cm H2O. Breath frequency wasset at 14 - 16 per minute. FiO2,PIP,ABG,HR, and BP were all recorded. Results Before treatment, 12 patientswere all in the state of respiratory failure and mental confusion, including lethargy and coma with PaO2. 6.18 ± 0.64kPa, pH7.14 ± 0.07 kPa, and PaCO2 10.6 1.53 kPa. After 2 - 8 hours, 24 hours, 48 hours, and 72 hours of PHVcombined with PEEP treatment, pH and PaO2 were all raised remarkbly (P＜0.01). However, PaCO2 was loweredstep by step above the normal level in 72 hours. All 12 patients were alive without any complications. ConclusionWith sufficient oxygen support, PHV combined with PEEP may gradually decrease PaCO2 and raise pH to normal lev-el. It has been proved to be an effcctive mechanical ventilation therapy of severe asthma. (Shanghai Med J, 2000,23:491-492)