Han Fang, Jiang Yu Y, Zheng Jian H, Gao Zhan C, He Quan Y
Department of Pulmonary Medicine, the People's Hospital, Beijing University, Beijing, China.
Sleep Breath. 2004 Jun;8(2):97-106. doi: 10.1007/s11325-004-0097-0.
This study describes the blood gases features and short-term outcomes with noninvasive positive pressure ventilation (NPPV) treatment in the management of acute respiratory failure (ARF) during a severe acute respiratory syndrome (SARS) epidemic. Between April 22 and May 1, 2003, 120 patients meeting clinical criteria for SARS were admitted to a hospital for infectious diseases in Beijing, China. At 6 weeks after onset, 25% of patients (30/120) had experienced ARF. Of interest, 16 of these patients (53%) exhibited hypercapnia (PaCO (2) > 45 mm Hg), and 10 hypercapnic events occurred within 1 week of admission. The occurence of hypencapnia or CO (2) retention and was accompanied by myalgias. NPPV was instituted in 28 patients; one was intolerant of NPPV. In the remaining 27 patients, NPPV was initiated 1.2 +/- 1.6 days after ARF onset. An hour of NPPV therapy led to significant increases in PaO (2) and PaO (2)/FiO (2) and a decrease in respiratory rate ( p < 0.01). Endotracheal intubation was required in one third of the patients (9 of 27) who initially had a favorable response to NPPV. Remarkable pulmonary barotrauma was noticed in 7 of all 120 patients (5.8%) and in 6 of those (22%) on NPPV. The overall fatality rate at 13 weeks was 6.7% (8/120); it was higher (26.7%) in those needing NPPV. No caregiver contracted SARS. We conclude that NPPV is a feasible and appropriate treatment for ARF occurring as a result of a SARS infection.
本研究描述了在严重急性呼吸综合征（SARS）流行期间，无创正压通气（NPPV）治疗急性呼吸衰竭（ARF）的血气特征和短期预后。2003年4月22日至5月1日，120例符合SARS临床标准的患者被收治入中国北京一家传染病医院。发病6周后，25%的患者（30/120）发生了ARF。有趣的是，其中16例患者（53%）出现高碳酸血症（PaCO₂>45 mmHg），10次高碳酸血症事件发生在入院1周内。高碳酸血症或二氧化碳潴留的发生伴有肌痛。28例患者接受了NPPV治疗；1例不耐受NPPV。在其余27例患者中，NPPV在ARF发病后1.2±1.6天开始使用。1小时的NPPV治疗导致PaO₂和PaO₂/FiO₂显著升高，呼吸频率降低（p<0.01）。最初对NPPV有良好反应的患者中有三分之一（27例中的9例）需要气管插管。在所有120例患者中有7例（5.8%）出现明显的肺气压伤，接受NPPV治疗的患者中有6例（22%）出现肺气压伤。13周时的总死亡率为6.7%（8/120）；需要NPPV治疗的患者死亡率更高（26.7%）。没有医护人员感染SARS。我们得出结论，NPPV是治疗SARS感染所致ARF的一种可行且合适的治疗方法。
