BIPAP模式治疗连枷胸合并肺挫伤

目的探讨双相气道正压通气（BIPAP）模式治疗连枷胸合并肺挫伤的临床效果。方法回顾性分析11例连枷胸合并肺挫伤的患者，出现呼吸功能不全需要机械通气时，均采用BIPAP模式，设计高呼气末正压通气（PEEP）、低PEEP、高PEEP持续时间、压力支持（PSV）、呼吸频率（f）、吸氧浓度（FiO2），当低PEEP≤6cmH2O、高PEEP≤10cmH2O、PSV≤5cmH2O、f≤4次／min、FiO2≤0，4时即可脱机。结果采用BIPAP模式治疗后患者症状、氧合指数、Pa02明显改善，经机械通气3—14d后一次性成功脱机，无一例发生急性呼吸窘迫综合征（ARDS）和死亡。结论对连枷胸合并肺挫伤采用BIPAP模式治疗能起到胸廓内固定，同时治疗急性肺损伤的共同作用，阻止ARDS的发生，是一种很好的机械通气方法。

Biphasic positive airway pressure treatment for flail chest associated with pulmonary contusion.

Objective To discuss the effect of biphasic positive airway pressure（ BIPAP ） mode in treatment of flail chest associated with pul- monary contusion. Methods A clinical retrospective analysis was carried out in study of 11 cases of flail chest associated with pulmonary contusion when mechanical ventilation was needed for respiratory dysfunction with BIPAP mode at designed high PEEP, low PEEP, high PEEP duration, respiration rate （f） and FiO2, Mechanical ventilation could be removed when low PEEPs〈6 cmH2O, high PEEP≤10 cmH2O, PSV≤5 cmH2O, f≤4 bpm and FiO2 ≤0.4. Results The symptoms, PaO2/FiO2 and PaO2 of patients were significantly improved after BIPAP for 3 to 14 days, and weaning from mechanical ventilator at one - time. There was no acute respiratory distress syndrome （ARDS） and death occurred in this series of cases. Conclusion Thoracic fixation can be provided with BIPAP mode in treatment of flail chest associated with pulmonary contusion. Acute lung injury can be treated with this kind of treatment and the occurrence of ARDS can also be prevented. Biphasic positive airway pressure mode is a good method for mechanical ventilation in patients with flail chest associated with pulmonary contusion.