摘要
目的 分析施行人工通气的重症传染性非典型肺炎 (SARS)患者的临床表现及治疗策略 ,为重症SARS的诊断和治疗提供依据。方法 总结 12例重症SARS患者的临床资料 ,全部患者均经鼻气管插管进行有创人工通气治疗 ,其中 9例经规范的无创通气治疗 ( 3～ 66h)失败后改用有创通气 ;全部患者均接受甲基强的松龙治疗 ,其中 6例剂量为 5 0 0mg/d ,其余为 2 40～ 3 2 0mg/d ;在疾病的不同阶段经验性应用大环内酯类、氟喹诺酮类及头孢类抗生素。结果 12例患者平均通气时间为 ( 10 7± 5 4)d ,通气前均有低氧血症 ,通气后氧合指数 (OI)上升 ,差异有非常显著性 (P <0 0 1) ;8例患者成功撤机 ,4例死亡。结论 及时进行有创人工通气可提高重症SARS患者的抢救成功率 ,起病时即出现肺部浸润并急剧进展、嗜中性白细胞分类增高及早期出现血痰者 ,提示病情严重 ,应严密监护 。
Objective To provide diagnostic and therapeutic basis for severe acute respiratory syndrome(SARS) by reviewing and analyzing the clinical data and therapeutic strategy of critical SARS patients receiving mechanical ventilation. Methods Retrospective analysis was performed in 12 patients with SARS. Twelve patients received invasive mechanical ventilation with transnasal endotracheal intubation following 9 of them failed to response to noninvasive ventilation(3 to 66 hours). All patients received methylpredisolone with a dose 500 mg/d in 6 patients and 240～320 mg/d in the remaining patients. Patients received macrolides, fluoquinolones or cephalosporins in different stage of the disease. Results The mean duration of invasive ventilation was (10 7±5 4) days in 12 patients. There was greatly significant difference before and after invasive ventilation in PaO 2 and OI( P <0 01). Eight patients weaned successfully from ventilator and the other 4 patients died. Conclusion Timely use of invasive mechanical ventilation can improve the success rate of rescuring SARS patient. Early presence and rapid exacerbation of pulmonary infiltration, neutrophilic leukocytosis and bloody sputum are signs of severe disease requiring careful monitor. High dose steroid in the progressive stage and invasive mechanical ventilation may reduce mortality in these patients.
出处
《广东医学》
CAS
CSCD
2003年第6期593-595,共3页
Guangdong Medical Journal
关键词
传染性非典型肺炎
人工通气
诊断
治疗
Infectious atypical pneumonia Clinical situation Mechanical ventilation
