摘要
目的：评价无创正压通气失败后被迫有创通气（ NIPPV-IV）和直接有创通气（ IV）治疗急性呼吸窘迫综合征（ ARDS）的疗效和安全性。方法回顾性分析2008年1月至2011年1月综合ICU的ARDS患者的临床资料，分为无创正压通气失败后进行有创通气治疗（ NIPPV-IV）组和直接有创通气治疗（ IV）组。结果 NIPPV-IV组47例，IV组90例，两组患者之间性别、年龄、APACHEⅡ评分、SOFA评分、SAPⅡ评分、肺损伤评分（ Lis）、ARDS来源、脓毒症严重程度无统计学意义（P＞0．05），经过治疗后，直接IV组中的器官功能不全数目、ICU住院时间和死亡率低于NIPPV-IV组，差异有统计学意义（P＜0．05）。结论 ARDS患者应慎用无创通气治疗，防止无创通气失败导致病情和预后不良，应及早建立人工气道行直接有创通气治疗。
Abstract
Objective To investigate the treatment efficiency of acute respiratory distress syndrome ,with the application of direct invasive ventilation and forced in-vasive ventilation after the failure of no -invasive positive pressure ventilation.Methods The clinical data of ARDS patients with the application of direct IV and NIPPV-IV were retrospectively analyzed from January 2008 to January 2011.Results direct IV group was 90 patients and NIPPV -IV group was 47 patients,the analysis showed that sexual,age,the acute physiology and chronic health evaluation Ⅱ(APACHEⅡ)scores,sequential organ failure assessment(SOFA)scores,simple acute physical(SAPⅡ)scores,lung injury scores,the original of ARDS,sepsis severity were no significant between direct IV group and NIPPV -IV group(p>0.05),after the different mechanical ventilation,the number of organ dysfunction,treatment days in ICU and mortality were significant between direct IV group and NIPPV -IV group(p<0.05).Conclusions ARDS patients should be established artificial airway directly for the application of invasive ventilation ,NIPPV should be used with caution in ARDS patients in order to avoid poor prognosis by its failure .
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