SARS危重患者机械通气后并发症的临床分析及呼吸治疗策略的探讨

首都医科大学学报 ›› 2003, Vol. 24 ›› Issue (4): 426-429.

SARS危重患者机械通气后并发症的临床分析及呼吸治疗策略的探讨

杨磊, 李非, 李铎, 贾建国, 杨鹏, 孙家邦

首都医科大学宣武医院外科ICU

收稿日期:2003-03-27 修回日期:1900-01-01 出版日期:2003-10-15 发布日期:2003-10-15

Complications after Mechanical Ventilation and Respiratory Treatment Strategy in Patients with Severe Acute Respiratory Syndrome

Yang Lei, Li Fei, Li Duo, Jia Jianguo, Yang Peng, Sun Jiabang

Surgical Intensive Care Unit, Xuanwu Hospital, Capital University of Medical Sciences

Received:2003-03-27 Revised:1900-01-01 Online:2003-10-15 Published:2003-10-15

摘要/Abstract

摘要： 回顾性分析31例行机械通气的严重急性呼吸综合征(SARS)危重病例,189例未行机械通气的SARS病例和近期外科ICU机械通气治疗的89例急性呼吸窘迫综合征(ARDS)病例,以分析危重SARS患者行无创或有创机械通气后气胸及纵隔气肿的发生情况,并探讨相应的呼吸治疗策略。结果31例行机械通气的SARS危重患者中9例出现气胸及纵隔气肿;189例未行机械通气的SARS患者中1例出现纵隔气肿;89例行机械通气的ARDS患者中1例出现气胸。与后两者相比较,行机械通气的SARS危重患者的气胸及纵隔气肿的发生率明显增高(P<0.01)。调整通气压力并适当提高吸入氧浓度,所有病例脉搏血氧饱和度(SpO₂)和改良呼吸指数均无明显变化。除1例有创机械通气患者行胸腔闭式引流术外,其余8例患者气胸及纵隔气肿均未进一步发展且逐步好转。提示行机械通气的SARS危重患者与未行机械通气的SARS患者及行机械通气的ARDS患者相比具有明显高的气胸及纵隔气肿发生率。这种现象可能与SARS造成肺脏损伤、剧烈咳嗽及机械通气压力过高有关。相应调整通气压力后绝大部分患者的气胸及纵隔气肿逐步好转。故此,对SARS危重患者行机械通气治疗时应该选择最佳的通气压力以避免气胸及纵隔气肿的发生。

关键词: 严重急性呼吸综合征, 气胸, 纵隔气肿, 机械通气, 无创正压通气

Abstract: The objective was to analyze the pneumothorax and mediastinal emphysema occurred after the non-invasive and invasive mechanical ventilation(MV)and to discuss relevant strategy in respiratory treatment in patients with critical severe acute respiratory syndrome(SARS).Altogether 31 serious cases of SARSundergoing MV were analyzed,retrospectively,in comparison with 89 cases of acute respiratory distress syndrome(ARDS)undergoing MV in surgical intensive care unit during the last two years.Re-sults:Pneumothorax and mediastinal emphysema occurred in 9 of 31serious cases of SARS with MV,and mediastinal emphysema in 1 of 189 cases of SARS without MV.Pneumothorax occurred in 1 of 89cases of ARDS with MV.The incidence of pneumothorax and mediastinal emphysema in serious cases of SARS with MV was significantly higher(P<0.01)than those in cases of SARS without MV and ARDS with MV.The peripheral blood oxygen saturation level and modified respiratory index didn't change significantly after reasonable adjustment of ventilation pressure and increase of oxygen concentration inhaled.Eight cases of pneumothorax and mediastinal emphysema improved gradually,thoracic closed drainage was performed in one case.Conclusions:The incidence of pneumothorax and mediastinal emphysema in serious SARS patients with MV is significantly higher than that in SARS patients without MV and that of ARDS patients with MV.It might be associated with SARS related pulmonary injuries,intense cough and high mechanical ventilative pressure.The pneumothorax and mediastinal emphysema improve gradually in most of the cases after reasonable adjustment of mechanical ventilative pressure.So when MV is used in the treatment of serious SARS patients to improve hypoxemia,optimized mechanical ventilative pressure should be obtained in order to avoid pneumothorax and mediastinal emphysema.

Key words: severe acute respiratory syndrome, pneumothorax, mediastinal emphysema, mechanical ventilation, non-invasive positive pressure ventilation

中图分类号:

R563.1

杨磊;李非;李铎;贾建国;杨鹏;孙家邦. SARS危重患者机械通气后并发症的临床分析及呼吸治疗策略的探讨[J]. 首都医科大学学报, 2003, 24(4): 426-429.

Yang Lei;Li Fei;Li Duo;Jia Jianguo;Yang Peng;Sun Jiabang. Complications after Mechanical Ventilation and Respiratory Treatment Strategy in Patients with Severe Acute Respiratory Syndrome[J]. Journal of Capital Medical University, 2003, 24(4): 426-429.

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