摘要目的 探讨保持气道完整对治疗重型病毒性肺炎合并急性呼吸窘迫综合征(ARDS)患者的意义.方法 32例确诊为重症病毒性肺炎合并ARDS的患者,全部在早期抗病毒治疗、抗细菌感染、支持等综合治疗措施的基础上,给予其中16例持续面罩高流量吸氧治疗,7例序贯治疗(给予持续面罩高流量吸氧治疗,24 h后动脉血氧分压、氧合指数较治疗前恶化后改为有创机械通气治疗),9例直接行气管插管有创机械通气治疗,观察三组疗效.结果 高流量吸氧组16例患者中5例死亡.该组患者治疗后48h、72h较治疗前动脉血氧分压、氧合指数均有改善(P值均＜0.05),而治疗后2h的变化没有统计学意义.序贯治疗组7例中死亡4例.有创机械通气组9例中死亡6例.序贯治疗组在序贯治疗后24 h及有创机械通气组在治疗后2h、24 h、48 h、72 h动脉血氧分压、氧合指数较治疗前均有改善(P值均＜0.05).高流量吸氧组与有创机械通气组病死率的差异有统计学意义(P＜0.05).结论 早期保护气道完整性的高流量吸氧可改善危重型病毒性肺炎合并ARDS患者的低氧血症,该治疗方法较气管插管机械通气治疗更可能降低病死率.

abstractsObjective To probe significance of protection to integrity of air passage in therapy to gravis type viral pneumonia complicating acute respiratory distress syndrome (ARDS). Methods 32 patients clinical diagnosed gravis type viral pneumonia complicating ARDS were cured by antiviral therapy,antibiotic,maintenance therapy and different oxygen therapies [16 patients cured by durative high flow oxygen therapy with face mask,seven patients cured by sequential therapy (they were cured by durative high flow oxygen therapy with face mask 48 hours,but their arterial partial pressure of oxygen and oxygenation index were aggravation than pretherapy,then they were given intubation mechanical ventilation),and nine patients cured by mechanical ventilation by tracheal intubation],then curative effect in three groups was obsrved.Results In 32 patients,five patients in the group of durative high flow oxygen therapy with face mask were dead,this group patients' arterial partial pressure of oxygen and oxygenation index post-treatment 48 hours,72 hours became better than pretherapy ( P ＜ 0.05).But some indexes had no statistical significance between post-treatment two hours and pretherapy.Four patients in the group of sequential therapy were dead,while six patients in the group of mechanical ventilation by tracheal intubation were dead.Their arterial partial pressure of oxygen and oxygenation index of post-treatment two hours in the group of sequential therapy and these of post-treatment 2,24,48,72 hours in the group of mechanical ventilation by tracheal intubation became better than pretherapy ( P ＜0.05).There was statistical significance between the difference of mortality in the group of durative high flow oxygen therapy with face mask and mechanical ventilation by tracheal intubation ( P ＜ 0.05).Conclusions High flow oxygen therapy can cure hypoxemia of gravis type viral pneumonia complicating ARDS,and maybe further reduce case fatality ratio than mechanical ventilation by tracheal intubation.