Smyth R J
Department of Anaesthesia, York County Hospital, Newmarket, Canada.
Can Respir J. 1998 Nov-Dec;5(6):485-90. doi: 10.1155/1998/356467.
Asthma continues to pose a significant medical problem in terms of both morbidity and mortality. A number of patients with a severe exacerbation of asthma fail medical therapy and require urgent intubation and mechanical ventilation. New modalities of ventilatory support, including noninvasive ventilation, have been shown to provide effective ventilation even in the presence of severe bronchoconstriction. An intrinsically high level of auto positive end-expiratory pressure in these patients requires a precise balance between respiratory frequency, tidal volume and inspiratory flow rates. Pressure support ventilation reduces the risk of barotrauma and lowers the work of breathing in these patients. Adjuvant therapy with inhaled anesthetics and bronchoalveolar lavage may also be indicated in patients requiring high pressures to achieve adequate ventilation.
哮喘在发病率和死亡率方面仍然是一个重大的医学问题。许多哮喘严重加重的患者药物治疗无效，需要紧急插管和机械通气。新的通气支持方式，包括无创通气，已被证明即使在存在严重支气管收缩的情况下也能提供有效的通气。这些患者内在的高水平内源性呼气末正压需要在呼吸频率、潮气量和吸气流量之间达到精确平衡。压力支持通气可降低这些患者发生气压伤的风险并减轻呼吸功。对于需要高压才能实现充分通气的患者，吸入麻醉剂和支气管肺泡灌洗的辅助治疗也可能适用。
