Braman S S, Kaemmerlen J T
Department of Medicine, Rhode Island Hospital, Providence.
JAMA. 1990 Jul 18;264(3):366-8.
Previous reports have disclosed a high morbidity and mortality in hospitalized asthmatics, especially those treated in the intensive care unit. Recently, it has been questioned whether the benefits of treating asthmatics in the intensive care unit outweigh the potential hazards. To address this issue, we examined the outcome of status asthmaticus in our medical intensive care unit between January 1, 1978, and December 31, 1987. Eighty episodes of status asthmaticus occurred in 64 patients. In 50 episodes, respiratory failure (PaCO2 greater than 50 mm Hg) was present. In half of these episodes, mechanical ventilation was avoided despite severe acidosis and hypercapnia; in the remainder mechanical ventilation was required as a lifesaving measure. Most patients improved rapidly and required only a short stay in the intensive care unit. There were no deaths and few complications. This was accomplished by close monitoring and repetitive blood gas analysis. We believe that the previous high complication rates and mortality associated with the hospital care of status asthmaticus can be avoided.
以往的报告显示，住院哮喘患者的发病率和死亡率很高，尤其是在重症监护病房接受治疗的患者。最近，有人质疑在重症监护病房治疗哮喘患者的益处是否超过潜在风险。为解决这个问题，我们调查了1978年1月1日至1987年12月31日期间我们内科重症监护病房中哮喘持续状态的治疗结果。64例患者发生了80次哮喘持续状态发作。其中50次发作出现了呼吸衰竭（动脉血二氧化碳分压大于50mmHg）。在这些发作中，尽管存在严重酸中毒和高碳酸血症，但有一半的发作避免了机械通气；其余发作则需要机械通气作为挽救生命的措施。大多数患者恢复迅速，仅需在重症监护病房短期停留。没有死亡病例，并发症也很少。这是通过密切监测和反复进行血气分析实现的。我们认为，以往与哮喘持续状态住院治疗相关的高并发症发生率和死亡率是可以避免的。
