有创与无创双水平气道正压通气序贯治疗急性呼吸窘迫综合征

摘要

Objective:To investigate the efficacy of sequential use of invasive and non-invasive bi-level positive airway pressure (BiPAP) ventilation in the treatment of acute respiratory distress syndrome (ARDS) .Methods :A total of 76 patients with ARDS of intensive care unit(ICU) were randomly divided into sequential treatment group with invasive and non-invasive BiPAP ventilation(group A ,n=38) and conventional synchronized intermittent mandatory ventilation (SIMV)group(group B ,n=38) . All patients with ARDS according to conventional therapy ,were early to be endotracheal intubation and SIMV .When the "ARDS control window”appeared in group A ,extubation was done and treatment was switched to sequential treatment of a nasal mask non-invasive BiPAP ventilation ,In group B ,SIMV was continued ,and weaned as model of SIMV+pressure support venti-lation(PSV) .Results:The time of the appearance of “ARDS control window” ,the indicators of vital signs ,and the indicators of arterial blood gas analisis in two groups were not statistically significant (P>0 .05) .Compared with that in group B ,the dura-tion of invasive mechanical ventilation and the total duration of mechanical ventilation were reduced ,the time in ICU was re-duced ,the incidence rate of ventilator associated pneumonia (VAP) and mortality rates in group A were lower (P<0 .05) .Con-clusions:The efficacy of sequential use of the invasive and non-invasive BiPAP ventilation in the treatment of ARDS is signifi-cant ,and can significantly shorten the duration of mechanical ventilation ,and to reduce the incidence of VAP and mortality .%目的：探讨有创与无创双水平气道正压通气（bi-level positive airway pressure ，BiPAP）序贯治疗急性呼吸窘迫综合征（acute respiratory distress syndrome ，ARDS）的疗效。方法：将重症监护病房（intensive care unit ，ICU）76例ARDS患者随机分为有创与无创BiPAP序贯治疗组（A组）38例和常规同步间歇指令通气（synchronized intermittent mandatory ventilation ， SIMV）组（B组）38例。所有患者均按ARDS常规治疗，尽早气管插管行SIMV ，当“ARDS控制窗”出现时，A组拔除气管插管，改用鼻面罩无创BiPAP序贯治疗，B组继续SIMV治疗，以SIMV＋压力支持通气（pressure support ventilation ，PSV）模式撤机。结果：2组患者“ARDS控制窗”出现时间、生命体征的指标和动脉血气分析的指标比较差异均无统计学意义（ P＞0．05）；与B组比较，A组有创通气时间及总机械通气时间均减少，入住ICU时间缩短，呼吸机相关性肺炎（ventilator associat-ed pneumonia ，VAP）发生率、病死率均降低（P＜0．05）。结论：有创与无创BiPAP序贯治疗ARDS的疗效显著，可明显缩短机械通气时间，降低VAP发生率及病死率。