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目的 评价机械通气治疗急性发作危重症哮喘的方法及疗效。方法 对 2 0 0 1- 0 1～ 2 0 0 3- 0 6沈阳军区总医院呼吸科收治的 2 2 8例重度和危重哮喘中 13例危重型哮喘患者 ,在内科综合治疗同时 12例经气管插管 ,1例经面罩行机械通气 ,前者起始模式为同步间歇指令通气 +压力支持 ,应用静脉肌松剂者为控制 /辅助模式 ,后者为持续正压通气 +压力支持。低潮气量 (6～ 8mL/kg)、慢呼吸频率 (10～ 12 /min) ,长呼气时间 (吸∶呼 >1∶2 ) ,吸气压 <2 5cmH2 O(1cmH2 O =0 0 98kPa) ,吸气时间 0 7～ 1 0s,气道阻力下降 ,症状体征改善 ,尽早撤机。结果 13例患者均抢救成功 ,平均 1 2 5h症状体征开始改善 ,上机 2 4h症状评分≤ 2分 ,上机平均时间 5 0 1h ,治疗后血气分析指标均恢复正常 ,最高呼气峰流量 (PEF)值显著增高 (P <0 0 1)。结论 机械通气是治疗急性发作危重症哮喘的有效方法 ,把握适应证 ,适当的模式和参数 ,尽早拔管和停机是成功的关键。
Objective To evaluate the method and effect of mechanical ventilation in the treatment of acute critical asthma. Methods Thirty-two cases of critically ill asthmatic patients with severe and severe asthma were enrolled in the Department of Respiratory Surgery, Shenyang Military Region General Hospital from January 2001 to December 2010, Intubation, 1 case of mechanical ventilation through the mask, the former starting mode for the synchronized intermittent mandatory ventilation + pressure support, the application of venous muscle relaxor for the control / assisted mode, the latter for continuous positive pressure ventilation and pressure support. Low tidal volume (6-8mL / kg), slow breathing rate (10-12 / min), long expiratory time (suction: 1: 2), suction pressure <2 5cmH2O (1cmH2O = 988Pa) , Inspiratory time 0 7 ~ 1 0s, airway resistance decreased, symptoms and signs improved, weaning as soon as possible. Results All the 13 patients were successfully rescued. The average symptom and symptom onset was improved after 125 days. The score of symptom on 24 hours was ≤ 2 points and the mean time on the machine was 51 hours. After treatment, the blood gas analysis indexes returned to normal, PEF) was significantly higher (P <0.01). Conclusions Mechanical ventilation is an effective method for the treatment of acute asthmatic attacks. To grasp indications, appropriate modes and parameters, extubation and shutdown as early as possible are the keys to success.