无创双水平气道正压通气治疗重症支气管哮喘的研究

目的探讨无创双水平正压通气（NIPPV）对重症支气管哮喘患者的治疗价值。方法将40例重症支气管哮喘患者按随机数字表法分成2组。对照组（n=20）予以氧疗、常规药物治疗;试验组（n=20）在氧疗、常规药物治疗的基础上予以NIPPV支持,应用美国STAR330型无创呼吸机,经面罩或鼻罩无创通气,采用S/T（自主呼吸/时间切换）,压力支持（PSV）＋呼吸末正压（PEEP）。比较2组治疗前和治疗后1、3h,第4天的血气分析指标（pH、PaCO2、PaO2、SaO2）的变化,治疗前后的最高峰流速（PEF）的改变及2组住院时间。结果治疗后,试验组血气分析指标以及PEF值的改善均较对照组明显（P〈0.05）;试验组住院时间较对照组明显缩短（P〈0.05）。结论对重症支气管哮喘患者早期应用NIPPV是有效的,但还需要大样本及更多的观察指标来监测患者的病情变化;对无创通气1～3h后病情无好转并呈进行性加重的患者应尽早改用有创机械通气,以免耽误治疗时机。

Bi-level Positive Airway Pressure Ventilation for Treatment of Severe Bronchial Asthma

Objective To investigate the clinical value of bi-level positive airway pressure（BiPAP）ventilation in treatment of severe bronchial asthma.Methods Forty cases of severe bronchial asthma were randomly divided into two groups,with 20 patients in each group.The patients in control group received oxygen therapy and conventional drugs,and the patients in experiment group received additional noninvasive positive pressure ventilation（NIPPV）besides oxygen therapy and conventional drugs.Patients were ventilated via facial or nasal masks with the ventilators（STAR 330 model BiPAP ventilation,American）,which were set in S/T mode and pressure support ventilation（PSV）mode＋positive end-expiratory pressure（PEEP）mode.The changes in arterial blood gas parameters（PH,PaCO2,PaO2,SaO2）and peak expiratory flow（PEF）before and after treatment,and the length of hospital stay were compared between the two groups.Results Compared with the control group,arterial blood gas parameters and PEF were obviously improved,and the length of hospital stay was significantly shortened in experiment group after treatment（P〈0.05）.Conclusion Bi-level positive airway pressure ventilation is effective in treatment of severe bronchial asthma,but more samples and indicators were required to monitor patient＇s condition changes.In addition,invasive mechanical ventilation must be used for treating the patients whose conditions do not improve or even aggravate asthma after 1～3 hours of treatment with NIPPV to avoid to delay treatment opportunity.