无创正压通气对产科危重症所致急性肺损伤的影响

目的探讨无创正压通气（Noninvasive Positive Pressure Ventilation,NIPPV）对产科危重症患者并发急性肺损伤（ALI）的影响。方法回顾性分析2001年1月至2008年12月收治的产科危重患者共67例。在治疗前,治疗后2、4、12、24和48 h监测并记录患者自觉症状、呼吸频率、心率、PaO2/Fi O2等动态变化。结果发生ALI的产科病例中以产后出血为最常见因素,占53.73%（36/67）。随NIPPV时间延长,患者自觉症状改善率逐步提高,但NIPPV后2、4 h呼吸困难改善率高于心悸症状改善率（P〈0.05）。使用NIPPV后2 h呼吸频率开始逐渐减慢,随着治疗时间的延长,呈现逐渐下降趋势（P〈0.05）,在治疗后12 h趋于稳定（P〉0.05）。NIPPV后4 h心率开始出现下降（P〈0.05）,直到NIPPV12 h后心率才再次继续逐渐下降（P〈0.05）。PaO2/Fi O2在NIPPV12 h后才开始改善,48 h后显著改善（P〈0.05）。94.03%（63/67）患者单纯使用NIPPV后能成功脱机,中转率5.97%（4/67）;1例发展为MODS死亡,死亡率1.49%（1/67）。结论产科危重症人群也是ALI发生的高危人群,对其应早期发现、早期诊断、早期行NIPPV,及时确定中转NIPPV时机,重视原发疾病的治疗是成功抢救的关键环节。

The Effect of Noninvasive Positive Pressure Ventilation on Critical Obstetrics Patients with Acute Lung Injury

Objective To investigate the effect of noninvasive positive pressure ventilation（NIPPV） on critical obstetrics patients with acute lung injury（ALI）.Methods A clinical retrospective analysis was carried out to investigate 67 critical obstetrics patients with ALI from January 2001 to December 2008.The subjective symptom,breathing frequency（BR）,heart rate（HR） and PaO2/FiO2 pretreatment,2,4,12,24 and 48 hours post-treatment were recorded.Results Postpartum hemorrhage,which was 53.73 percents（36/67）,was the most common factor of ALI on obstetrics patients with critical illness.Following the lasting of NIPPV,the improvement rate of subjective symptom increased gradually,but the improvement rate of anhelation was higher which was compared with the improvement rate of palmus after 2 and 4 h of treatment（P0.05）.BR began to step down gradually after 2 h of treatment then fell-off along with the lasting of NIPPV（P0.05）,and to be stabilization after 12 h of treatment（P0.05）.HR began to decrease after 4 h of treatment,and it fell off again after 12 h of treatment（P0.05）.PaO2/FiO2 began to improve after 12 h of treatment and improve significantly after 48 h of treatment（P0.05）.94.03 percents（63/67） patients could be off-line after NIPPV simply.5.97% percents（4/67） patients were changed into the therapy of invasive mechanical ventilation（IMV）.The death rate was 1.49%（1/67） because of MODS.Conclusion The group of obstetrics patient with critical illness was one of high-risk group of ALI.The component elements include early discovery,early diagnosis,using NIPPV early to ALI,changing into the therapy of IMV in time and healing primary disease either.