Zimmerman J L, Dellinger R P, Shah A N, Taylor R W
Department of Medicine, Baylor College of Medicine, Houston, TX.
Crit Care Med. 1993 Nov;21(11):1727-30. doi: 10.1097/00003246-199311000-00023.
To determine the occurrence rate of complications and mortality in patients with severe asthma requiring endotracheal intubation and mechanical ventilation.
Retrospective review of medical records from September 1982 to July 1988.
Urban, teaching hospital serving primarily indigent patients.
Fifty-seven adult patients with asthma requiring tracheal intubation and mechanical ventilation.
None.
Fifty-seven patients requiring tracheal intubation and mechanical ventilation during 69 hospital admissions were identified. Medication noncompliance and upper respiratory tract infections were recorded as the most frequent precipitating events for exacerbation of asthma. Forty-nine intubations were initiated because of a clinical diagnosis of respiratory distress, but multiple indications were present in 42 admissions. One or more complications occurred in 31 episodes of endotracheal intubation and mechanical ventilation (45%). Death occurred in four (6%) of 69 admissions. Three of the four deaths occurred in patients who had a cardiorespiratory arrest before hospital admission.
While complications occurred in 45% of patients with severe asthma requiring intubation and mechanical ventilation, the mortality rate was low. We conclude that intubation and mechanical ventilation in patients with life-threatening asthma are safe and beneficial interventions.
确定需要气管插管和机械通气的重度哮喘患者的并发症发生率和死亡率。
对1982年9月至1988年7月的病历进行回顾性研究。
主要为贫困患者服务的城市教学医院。
57例需要气管插管和机械通气的成年哮喘患者。
无。
共确定69次住院期间需要气管插管和机械通气的57例患者。用药依从性差和上呼吸道感染被记录为哮喘加重最常见的诱发事件。49次插管是由于临床诊断为呼吸窘迫而开始的，但42次住院存在多种指征。31次气管插管和机械通气过程中发生了一种或多种并发症（45%）。69次住院中有4例（6%）死亡。4例死亡中有3例发生在入院前发生心肺骤停的患者。
虽然45%需要插管和机械通气的重度哮喘患者发生了并发症，但死亡率较低。我们得出结论，对危及生命的哮喘患者进行插管和机械通气是安全有益的干预措施。
