有创-无创序贯通气治疗急性有机磷农药中毒致中间期肌无力综合征

[目的]探讨有创-无创序贯通气治疗急性有机磷农药中毒(AOPP)致中间期肌无力综合征(IMS)合并急性呼吸衰竭(ARF)的可行性及疗效.[方法]AOPP致IMS合并ARF有创机械通气的45例患者,出现IMS控制窗后,随机分为有创机械通气治疗组(简称有创组,20例) 和有创-无创序贯通气治疗组(简称序贯组,25例).记录序贯组患者改无创通气治疗前、后2 h、24 h动脉血气、心率(HR)、呼吸(RR)、血氧饱和度(SpO2)值 ,并统计所有患者再次气管插管率、呼吸机相关性肺炎发生率及有创通气时间、总机械通气时间、住ICU时间及费用情况.[结果]序贯组患者改无创通气前、后2 h、24 h生命体征及动脉血气比较差异无显著性(P＞0.05);撤机后序贯治疗组在有创通气时间、总机械通气时间、住ICU 时间明显缩短(P＜0.05);住院费用明显下降(P＜0.05);呼吸机相关性肺炎(VAP)的发生率序贯治疗组明显下降(P＜0.05);序贯治疗组重新气管插管率明显低于对照组(P＜0.05).[结论]有创-无创序贯通气能有效治疗AOPP致IMS合并ARF,并较常规有创机械通气治疗减少再插管率、VAP发生率及机械通气时间及费用等,临床可积极尝试.

Sequential Invasive, Noninvasive Mechanical Ventilation in Intermediate Myasthenia Syndrome due to Acute Organophosphorus Pesticides Poisoning

[Objective]To investigate the changes in acute organophosphorus pesticides poisoning(AOPP) patients with intermediate myasthenia syndrome ( IMS) during sequential invasive, noninvasive mechanical ventilation therapy ,and evaluate the effects of this new technique.[Methods]Forty five AOPP patients with IMS were ventilated through an endotracheal tube.When the IMS window occurred ,the patients were divided into two groups randomly :traditional group (20 cases) and BiPAP group (25 cases) . The parameters of hemodynamics ,oxygen dynamics were measured before and after two hours of non - invasive mechanical ventilation ,and the reintubation rate and cost were calculated. The traditional group was treated with conventional therapy alone.[Results]There was no difference in clinical characteristics and gas exchange at entry. There were no significant differences in respiratory and circulatory parameters after treatment in BiPAP group (P>0.05) . Compared with the traditional group ,the time of invasive mechanical ventilation ,total time of ventilatory assistance and hospitalized time in ICU,total cost of therapy were decreased markedly in BiPAP group(P<0.05) ,and the incidence of ventilator associated pneumonia (VAP) was also decreased markedly(P<0.05) . Reintubation rate was higher in the traditional group(P<0.05) .[Conclusion]The IMS patients can tolerate the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.BiPAP can improve ventilation function and reduce the reintubation rate,cost,VAP and hospitalized time in ICU in regular mechanical ventilation.