经鼻(面)罩通气治疗急性呼吸窘迫综合征

目的评价经鼻（面）罩机械通气治疗急性呼吸窘迫综合征（ABDS）的疗效。方法16例ARDS患者分为感染组（7例）和非感染组（9例），前者呼吸频率（RR）（46±5）次／分，动脉血pH、二氧化碳分压（PaCO2）、氧合指数（OI）分别为7．49±0．05、（32±4）mmHg、（144±23）mmHg；后者为（41±6）次／分、7．49±0．13、（32±5）mmHg、（156±51）mmHg，经鼻（面）罩选择压力支持通气（PSV）＋呼气末正压（PEEP）。结果通气2－8h，与通气前比较感染组RR为（45±7）次／分，P＞0．05，OI升至（195±30）mmHg，P＜0．05；非感染组相应为（35±4）次／分和（228±90）mmHg（P＜0．05）。10例治愈，治愈率分别有29％（2／7）和89％（8／9）。结论　经鼻罩机械通气可作为治疗非感染性因素诱发的ARDS　的首选通气方式，而在感染患者应及早建立人工气道。

Nasal or oranasal face mask mechanical ventilation in the treatment of acute respiratory distress syndrome

OBJECTIVE: To Evaluate the effect of nasal or oranasal face mask mechanical ventilation (FMMV) in the treatment of patients with acute respiratory distress syndrome(ARDS). METHODS: 16 ARDS patients were separated into two groups: infection group and non-infection group. The former had 6 cases with pneumonia and 1 case with sepsis; the later had 5 cases with multiple fracture, 2 with operation of intestines obstruction, 1 with operation of spleen rupture, 1 with hepatectomy. In Infection group, the respiratory rate(RR) was (46 +/- 5) times/min, the arterial blood pH 7.49 +/- 0.05, CO2 partial pressure(PaCO2) was (32 +/- 4) mm Hg, and oxygenation index (OI) (144 +/- 23) mm Hg. In non-infection group, the RR, pH, PaCO2, OI was (41 +/- 6) times/min, 7.49 +/- 0.13, (32 +/- 5) mm Hg, (156 +/- 51) mm Hg. All patients were linked with ventilator via nasal or ornasal mask. Pressure support ventilation (PSV) and positive end-expiratory pressure (PEEP) were selected. RESULTS: All patients successfully received FMMV. In infection group, RR and OI returned to (45 +/- 7) times/min (P > 0.05) and (195 +/- 30) mm Hg(P < 0.05) respectively after 2-8 hours via FMMV. But in non-infection group, the RR and OI were (35 +/- 4) times/min (P < 0.05) and (228 +/- 90) mm Hg(P < 0.05). 2 cases(29%) in infection group and 8 cases(89%) in non-infection were successfully weaned from FMMV. CONCLUSION: FMMV could be as the first choice in ARDS patients without infection, and airway intubation should be given in infectious patients as early as possible.