同步间歇指令性通气联合压力支持通气抢救急性有机磷农药中毒致呼吸衰竭

目的 研究同步间歇指令性通气联合压力支持通气抢救有机磷农药中毒致呼吸衰竭的效果。方法 入院后给常规解毒治疗,同时行机械通气,初期无自主呼吸者应用控制通气,随着自主呼吸的逐渐好转改用同步间歇指令+压力支持通气。根据潮气量、呼吸频率、血氧饱和度、血气分析等通气氧合指标逐渐降低同步间歇指令性通气的频率至2～4bpm,同时调整压力支持至0.392～0.588kPa,吸入氧浓度<40％,达到脱机标准,予脱离呼吸机。结果 27例患者住院17～30天,平均22天;MV1～20天,平均8.5天;静注阿托品10～15天,平均12天;共用阿托品针120～2660mg,平均585mg。其中IMS5例,MV12～20天,平均16天;单纯ACC致呼吸衰竭22例,MV1～11天,平均5.5天。两组比较t=187.5,P<0.01,有显著性差异。结论 同步间歇指令性通气联合压力支持通气的机械通气模式对抢救急性有机磷中毒致呼吸衰竭是有效、可靠的。

Synchronized Intermittent Mandatory Ventilation Associating with Pressure Support Ventilation Therapy on the Patients of Respiratory Failure with Acute Organophosphate Poisoning

Objective To study the effect of synchronized intermittent mandatory ventilation associating with pressure support ventilation therapy on the patients of respiratory failure with acute organophosphate poisoning. Methods The patients of respiratory failure with acute organophosphate poisoning were given routine detoxication therapy,and at the same time, gave them mechanical ventilation therapy. In the initial stage gave the patients without autonomous breathing ontrolled ventilation. When the patients get autonomous breathing again gradually,gave them synchronized intermittent mandatory ventilation associating with pressure support ventilation therapy. Gradually reduced the frequency of synchronized intermittent mandatory ventilation to 2-4 bpm according to the ventilation and oxygenation marker as tidal volume,respiratory rate,blood oxygen saturation,blood gas analysis and so on,simultaneously adjusted the pressure of pressure support ventilation to 0. 392 ~0. 588kPa and the aspiration oxygen concentration to lower than 40%(FiO2<40%). When the patients achieved the standard of detachment,stop using respirator. Results The hospitalization days of the 27 cases were 17-30 days,the mean hospi-talization days were 22 days. The mechanical ventilation days were 1 - 20 days,the mean days were 8. 5 days. The days of at-ropine with injection of vein were 10-15 days,the mean days were 12 days. The total quantity of atropine with injection of vein was 120-2660mg,the mean quantity was 585 mg. Among these cases,the mechanical ventilation days of the 5 cases with IMS were 12~20 days,the mean days were 16 days,then the mechanical ventilation days of the 22 cases with respiratory failure of ACC were 1~11 days,the mean days were 5. 5 days. From the comparison of two groups,there was a significant discrepancy with t=187. 5,P<0. 01. Conclusion It is an effective and reliable method for synchronized intermittent mandatory ventilation associating with pressure support ventilation therapy was used to rescue the patients of respiratory failure with a-cute organophosphate poisoning