协和医学杂志

2013, v.4(03) 265-268

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肺间质纤维化合并严重呼吸衰竭患者的机械通气策略
Mechanical Ventilation Strategy in Pulmonary Fibrosis with Severe Respiratory Failure

郑亮亮;朱华栋;徐军;刘业成;刘继海;于学忠;
ZHENG Liang-liang,ZHU Hua-dong,XU Jun,LIU Ye-cheng,LIU Ji-hai,YU Xue-zhong Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

摘要(Abstract):

目的研究肺间质纤维化合并严重呼吸衰竭患者的机械通气策略。方法 54例肺间质纤维化合并呼吸衰竭患者分为无创通气组(21例)和有创通气组(33例),观察两组患者机械通气前后动脉血气的变化以及机械通气治疗期间出现的并发症,计算两组患者死亡率及平均住院时间。结果两组患者接受机械通气治疗1h后氧合均得到明显改善(P<0.01)。无创通气组患者机械通气治疗期间并发症发生率为23.8%,明显少于有创通气组的51.5%(P=0.043);无创通气组和有创通气组患者死亡率分别为90.5%和93.9%,两组差异无统计学意义(P=0.636);无创通气组患者平均住院时间为(13.1±11.7)d,明显少于有创通气组的(19.4±15.8)d(P=0.008)。结论对于肺间质纤维化合并严重呼吸衰竭患者,无创正压通气和有创通气均难以改善预后,但无创正压通气因并发症较少且住院时间短,可尝试使用。
Objective To study the strategy of mechanical ventilation in pulmonary fibrosis with severe respiratory failure. Methods Fifty-four pulmonary fibrosis patients with severe respiratory failure requiring ventilatory support were divided into noninvasive ventilation group ( n = 21) and invasive ventilation group ( n = 33) . The patients in noninvasive ventilation group were treated with noninvasive bi-level positive airway pressure ( BiPAP) ventilation,and the patients in invasive ventilation group underwent endotracheal intubation and mechanical ventilation. Arterial blood gas was detected before ventilation and after one hour of ventilatory support. The complications of mechanical ventilation,mortality rate,and length of hospital stay were recorded. Results Significant improvements in PaO2 after one hour of ventilatory support were noted in both groups ( P < 0. 01) . The incidence rate of complications in noninvasive ventilation group was lower than that in invasive ventilation group ( 23. 8% versus 51. 5%,P =0. 043) . No significant difference was found in the mortality rate between these two groups ( 90. 5% versus 93. 9% ,P = 0. 636) . The hospital stay of noninvasive ventilation group was significantly shorter than that of invasive ventilation group ( 13. 1 ± 11. 7 days versus 19. 4 ± 15. 8 days,P = 0. 008) . Conclusions Neither noninvasive ventilation nor invasive mechanical ventilation can remarkably improve the survival of pulmonary fibrosis patients with severe respiratory failure. However,noninvasive ventilation can be applied in selected patients due to its lower incidence of complication and shorter hospital stay.

关键词(KeyWords): 肺间质纤维化;呼吸衰竭;机械通气;双水平气道正压通气
pulmonary fibrosis; respiratory failure; mechanical ventilation; bi-level positive airway pressure

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作者(Author): 郑亮亮;朱华栋;徐军;刘业成;刘继海;于学忠;
ZHENG Liang-liang,ZHU Hua-dong,XU Jun,LIU Ye-cheng,LIU Ji-hai,YU Xue-zhong Department of Emergency,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College,Beijing 100730,China

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