Đánh giá kết quả thông khí không xâm nhập hai mức áp lực dương trong điều trị suy hô hấp cấp tại Khoa cấp cứu Bệnh viện Bạch Mai năm 2001-2005

joint meeting of the American Society of Retina

Specialists and European

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Vitreoretinal surgical techniques. London: Martin Dunitz

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vitreous hemorrhage after vitrectomy for diabetic

retinopathy. Am J Ophthalmol, 103:146-9.

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diabetic vitrectomy. In: Lewis H, Ryan SJ (eds). Medical

and surgical retina: Advances, controversies and

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retinopathy. Ophthalmology, 91:1485-9.

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Regression of iris neovascularization after Intravitreal

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diabetic retinopathy. Am J Ophthalmol, 142:155-8.

DANH GIA KET QUA THONG KHI KHONG XAM NHAP HAI MUfC AP UfZ DUUNG

TBONG DIEU TBj SUY HO HAP CAP

TAI KHOA CAP CUU BENH VIEN BACH MAI NAM 2001 - 2005

TOMTAT:

Muc tieu nghien ewu: Dinh gii kit qui vi lam

sang va khi miu dong mach ciia thdng khi khong

xSm nhap (TKKXN) hai mire ip Iwc dwong (BiPAP)

trong dieu tn mot sd tinh trang suy hd hip cip

(SHHC). Xac dinh mot sd yeu to tien Iwong thinh

cong ciia thdng khi khdng xam nhap hai mire ip Iwe

dwong trong diiu tri suy hd hip cip.

Phwong phap nghien ciru: Chung tdi tien hinh

nghiSn ciru hdi ciru trdn 113 benh nhan SHHC mire

do vira vi ning) vao khoa cip ciru b§nh vien Bach

Mai tir thing 1 nam 2001 den thing 12 nam 2005,

dwoc TKKXN BIPAP. Chung tdi eiiia thinh hai nhdm

gom nhdm dot cip benh phoi tie nghen man tinh

(COPD) (77%,) va nhdm eae benh khie (phii phdi

cap, hen phe quan, viem phoi) (23%). Dinh gii thinh

cong la benh nhan bd dwoc TKKXN BiPAP mi khdng

phai dat ndi khi quan.

Kit qua: Ty le thinh edng ehung li 67.3%, trong

dd nhdm COPD thanh cong cd ty le thinh edng eao

han, 73,6%, (p < 0,01). Dau hieu lam sing vi khi miu

dong mach dwoc cii thien sau 1 gid TKKXN BiPAP.

Cic yeu to lien quan den ty le thinh edng eao cua

TKKXN li: APACHE II < 17 (OR 7,1; 95% CI 2,73 to

18,26) tnrdc khi TKKXN, 7,35 < pH < 7,45 (OR 7,6;

95%oCI 1,52 -37,64), vi nhip thd < 25/phut (OR 6,2;

95% CI 2,2- 12,2) sau 1 gid TKKXN.

Ket luSn: TKKXN hai mire ip Iwe dwong (BiPAP)

c6 hieu qui trong dieu tri SHHC khi ip dung tai khoa

cip ciru. TKKXN hai mire ip Iwe dwong (BIPAP) giup

cai thien cic dau hieu lam sing, khi miu ddng mach

va giup phin Idn b§nh nhan trinh phai dat ndi khi

quan. Cic yeu to tien Iwong TKKXN hai mire ip Iwc

dwong (BiPAP) se thinh cong li: diem APACHE li <

17 (tnrde TKKXN BiPAP), suy hd hap mire dd vira

(tnrdc TKKXN BiPAP), Tin s6 thd < 25 Ian/phut (sau

TKKXN BiPAP 1 gid) vi pH miu ddng mach trong

khoang 7,35 - 7,45 (sau TKKXN BIPAP 1 gid).

Tir khda: khi miu ddng mach, ip Iwc dwong

0 0 MINH DUONG, PHUNG NAiVI LA M

SUMMARY

Objectives: This study aimed to adjust the result

of noninvasive positive pressure ventilation (NPPV) in

patients presenting with Acute Respiratory Failure

(ARE) to the Emergency Department (ED). The

second aim was to determine the factors associated

with success of noninvasive positive pressure

ventilation.

Methods: We retrospectively analyzed 113

patients admitted to the ED for acute respiratory

failure (moderate and sen/ere levels) and who were

treated with NPPV. Success of NPPV was defined as

patients withdrawing NPPV and not required

endotracheal intubation at anytime.

Results: Success rate of NPPV was 67.3%,

(76/113). It was higher in the exacerbation of chronic

obstructive pulmonary disease (73.6%). Factors

associated with success of NPPV were APACHE II ^

17 (OR 7.1; 95%, CI 2.73 to 18.26) before NPPV, 7.35

< pH < 7.45 (OR 7.6; 95%oCI 1.52 to 37.64), and

respiratory rate (RR) < 25 breaths per min (OR 6.2;

95%oCI 2.2 to 12.2) after one hour of NPPV.

Conclusions: NPPV was frequently effective in

ARE and reduced the need for endotracheal

intubation. The factors predict of success were:

APACHE II <, 17, ARE of moderate level before

NPPV, 7.35 < pH < 7.45 and RR < 25 breaths per

minus after one hour of NPPV.

Keywods: Acute Respiratory Failure, Emergency

Department

OATVANOe

Suy ho hap d p (SHHC) IS tinh trang b$nh ly

thudng gSp trong khoa elp ciru, cd ty le tir vong cao.

Benh nhSn SHHC thudng phai hd trp hd hap bing

thdng khi xSm nhSp (TKXN) hay thong khi khdng xSm

nhSp (TKKXN) [1]. TKXN qua dng noi khi quan (NKQ)

hay md khi quan (MKQ) tuy hieu qua nhung c6 nguy

CO gay nhieu bien chirng lien quan den cd dng NKQ

nhu tae dng NKQ, viem phdi benh vien...hoSc khd

Y HOC THl/C HANH (729) - SO 8/2010 15