Schultze-Werninghaus G, Duchna H W, Rasche K, Orth M
Medizinische Klinik III, Berufsgenossenschaftliche Kliniken Bergmannsheil, Klinikum der Ruhr-Universität Bochum.
Internist (Berl). 2004 May;45(5):518-26. doi: 10.1007/s00108-004-1174-y.
The underlying causes of acute severe or life threatening asthma are infections with respiratory viruses or Mycoplasma pneumoniae, rather than bacterial infections. In addition, exposure to various agents such as allergens, non-specific irritants or drugs, and inadequate long-term treatment may be responsible. High flow oxygen therapy, high dose topic beta(2)-agonists and systemic glucocorticosteroids should be used as baseline therapy in outpatients. In hospital, intravenous therapy-eventually including sedatives-can be administered under controlled or intensive care conditions. In patients with increasing respiratory pump weakness and alveolar hypoventilation, non-invasive and/or invasive mechanical ventilation may be required. In ventilated asthma patients permissive hypercarbia has been shown to reduce complications such as pneumothorax. Bronchoscopy and bronchial lavage are recommended for patients ventilated with increasing pressures or when atelectasis occurs.
急性重症或危及生命的哮喘的根本原因是呼吸道病毒或肺炎支原体感染，而非细菌感染。此外，接触各种因素，如过敏原、非特异性刺激物或药物，以及长期治疗不足也可能是原因。高流量氧疗、高剂量局部β₂激动剂和全身性糖皮质激素应用于门诊患者的基础治疗。在医院，可在控制或重症监护条件下给予静脉治疗，最终可能包括镇静剂。对于呼吸泵功能逐渐减弱和肺泡通气不足的患者，可能需要无创和/或有创机械通气。在机械通气的哮喘患者中，允许性高碳酸血症已被证明可减少气胸等并发症。对于机械通气时压力不断升高或发生肺不张的患者，建议进行支气管镜检查和支气管灌洗。
