Limthongkul S, Wongthim S, Udompanich V, Charoenlap P, Nuchprayoon C
Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 1990 Jun;73(6):321-8.
Mechanical ventilation in 75 out of 560 status asthmaticus episodes during a five-year period (1984-1988) at Chulalongkorn Hospital were analyzed. There were 58 patients with an average age of onset of first asthmatic attack of 18.5 years and an average age when requiring mechanical ventilation of 33 years, which is significantly younger than among those who did not require assisted ventilation. At the time of intubation, four patients were in sudden unexpected arrest and 19 patients were urgently ventilated because of respiratory muscle fatigue or carbon dioxide narcosis; the remaining 52 patients required elective mechanical ventilation. The arterial blood gas of 52 patients revealed a pH of 7.11 +/- 0.66, PaCO2 of 58.0 +/- 5.5 mmHg, and HCO3 of 15.0 +/- 5.8 mEg/L. Controlled mechanical ventilation was maintained for a mean of 38.68 hours. Fifty-one patients required intravenous diazepam (average dose = 24.3 mg) and 37 required morphine (average dose = 11.1 mg) for good syncronization in controlling mechanical ventilation. Pneumothorax was the most common complication with four, nine and one episodes occurring prior to, during and after assisted ventilation, respectively. Four, one and two patients developed the complications of pneumonia, atelectasis of the left lung due to mucous plugging and upper gastrointestinal hemorrhage, respectively. There were six patients who died of complications: four of brain anoxia, one of pneumothorax and another of unexplained cause.
对朱拉隆功医院在五年期间（1984 - 1988年）560例哮喘持续状态发作中的75例机械通气情况进行了分析。有58名患者，首次哮喘发作的平均起病年龄为18.5岁，需要机械通气时的平均年龄为33岁，这明显低于那些不需要辅助通气的患者。插管时，4例患者突然意外心跳骤停，19例因呼吸肌疲劳或二氧化碳麻醉而紧急通气；其余52例患者需要择期机械通气。52例患者的动脉血气显示pH值为7.11±0.66，动脉血二氧化碳分压（PaCO2）为58.0±5.5 mmHg，碳酸氢根（HCO3）为15.0±5.8 mEq/L。控制性机械通气平均维持38.68小时。51例患者需要静脉注射地西泮（平均剂量 = 24.3 mg），37例需要吗啡（平均剂量 = 11.1 mg）以在控制机械通气时达到良好同步。气胸是最常见的并发症，分别在辅助通气前、通气期间和通气后发生4例、9例和1例。分别有4例、1例和2例患者出现肺炎、黏液堵塞导致左肺肺不张和上消化道出血并发症。有6例患者死于并发症：4例死于脑缺氧，1例死于气胸，另1例死因不明。
