机械通气前PaCO2水平预测支气管哮喘患者预后的研究

目的 探讨机械通气前PaCO2水平与支气管哮喘患者预后的关系.方法 对2010年1月-2012年12月中国医科大学附属第一医院急诊科监护室收治的接受机械通气的67例支气管哮喘患者的临床资料进行回顾性分析,根据患者机械通气前的PaCO2水平分为低PaCO2组[PaCO2≤35mmHg（1 mmHg =0.133 kPa）] 19例、正常PaCO2组（35 mmHg＜ PaCO2 ＜45 mmHg）21例和高PaCO2组（PaCO2≥45 mmHg）27例,分析比较各组患者的住院期间病死率、机械通气时间和ICU救治时间等.结果 患者住院期间病死率为低PaCO2组5.3％ （1/19）、正常PaCO2组9.5％（2/21）和高PaCO2组14.8％ （4/27） （x2=1.16,P＞0.05）;平均机械通气时间分别为（5.6±1.7）d、（8.3±2.1）d和（13.5 ±3.6）d（F =3.36,P=0.042）;平均ICU救治时间分别为（7.4±2.1）d、（11.5±3.3）d和（16.4±3.5）d,（F =3.23,P=0.047）;患者气管插管前PaCO2水平与机械通气时间和ICU救治时间呈正相关（r2 =0.366和0.316,P=0.031和0.029）.结论 机械通气前的PaCO2水平可能是预测支气管哮喘患者预后的指标之一,急诊机械通气的时机影响患者机械通气时间和ICU救治时间.

Right timing of mechanical ventilation in patients with bronchial asthma in emergency room

Objective To explore the right timing of mechanical ventilation in patients with bronchial asthma in emergency room.Methods A total of 67 patients with bronchial asthma undergoing mechanical ventilation were admitted into our Emergency Intensive Care Unit （EICU） from January 2010 to December 2012.According to PaCO2 before intubation,they were divided into 3 groups of low levels of PaCO2 [PaCO2 ≤35 mmHg （1 mmHg =0.133 kPa）] （n =19）,normal PaCO2 （35 mmHg 〈 PaCO2 〈 45 mmHg） （n =21） and high PaCO2 （PaCO2 ≥ 45 mmHg） （n =27）.Their clinical data were retrospectively analyzed.Results The in-hospital mortality of three groups were 5.3% （1/19）,9.5% （2/21） and 14.8% （4/27） and the difference was not statistically significant （x2 =1.16,P 〉 0.05）.However the average duration of mechanical ventilation of three groups were （5.6 ± 1.7）,（8.3 ± 2.1） and （13.5 ±3.6） days and the difference was statistically significant （F =3.36,P =0.042）.The average ICU treatment time was （7.4 ± 2.1）,（11.5 ± 3.3） and （16.4 ± 3.5） days and the difference was statistically significant （F =3.23,P =0.047）.PaCO2 levels before intubation was positively correlated with the duration of mechanical ventilation and the ICU treatment time （r2 =0.366,0.316,P =0.031,0.029）.Conclusion The patients with bronchial asthma undergoing intubation in right time in emergency room will affect the duration of mechanical ventilation and ICU treatment time.