家庭无创正压通气在慢性阻塞性肺疾病稳定期患者中的疗效

目的 研究稳定期慢性阻塞性肺疾病并慢性呼吸衰竭患者家庭氧疗加用无创正压通气与单独应用家庭氧疗治疗的疗效.方法 慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者使用家庭氧疗加无创正压通气与单纯长期家庭氧疗患者比较在治疗1年中的病情恶化次数、住院次数、住院时间以及治疗前与治疗12个月后的血气指标和肺功能参数的变化和症状、体征.结果 随访12个月后,家庭氧疗加用无创正压通气治疗组病情恶化次数和住院次数均较单纯氧疗组明显减少.在治疗12个月随访时,家庭氧疗加用无创正压通气治疗组的动脉血氧分压(PaO2),动脉血二氧化碳分压(PaCO2),血液pH与单纯氧疗组比较均有显著改善,差异有统计学意义(P<0.05).结论 无创正压通气是慢性阻塞性肺疾病稳定期并慢性呼吸衰竭患者积极和有效的治疗措施. Abstract： Objective To study the clinical value of home non-invasive positive pressure ventilation(NIPPV) in patients with stable-phase chronic obstructive pulmonary disease(COPD)and chronic respiratory failure.Methods Stable COPD patients complicated with chronic respiratory failure received Bi-level positive airway pressure ventilation.The frequency of acute exacerbation,admissiontimes-admission expending,blood gas analysis were compared in these patients with those received long term oxygen therapy. Results After one year home non-invasive positive pressure ventilation,PaCO2,HCO-3 were decreased,while pH and PaO2 increased.Compared with patients received long term oxygen therapy,PaCO2 was greatly ameliorated and the frequency of acute exacerbation,admission times and admission expending declined.Conclusions Home non-invasive positive pressure ventilation will do good to COPD patients with hypercapnic respiratory failure during stable phase.     

无创正压通气联合纳洛酮治疗慢性阻塞性肺病并发Ⅱ型呼吸衰竭29例疗效观察

2003年7月至2006年7月作者应用无创正压通气(noninvasive positive pressure ventilation,NIPPV)[1] 治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease, COPD)并发Ⅱ型呼吸衰竭患者23例(NIPPV组),应用NIPPV联合纳洛酮治疗COPD并发Ⅱ型呼吸衰竭患者29例(NIPPV加纳洛酮组),同20例常规治疗(对照组)进行疗效比较,报道如下.     

无创正压通气在临床中的应用

无创正压通气（noninvasive positive pressure ventilation，NIPPV）是无创通气（NIV）的一种，是目前治疗呼吸衰竭尤其是慢性阻塞性肺疾病（COPD）合并呼吸衰竭的重要的、首选的治疗措施。     

无创双水平正压通气在老年慢性阻塞性肺疾病中的应用

目的探讨无创双水平正压通气技术(bi-level positive airway pressure ventilation,BiPAP)在老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)合并呼吸衰竭中的疗效。方法将50例老年COPD合并呼吸衰竭患者分为通气组和对照组,比较两组患者的临床治疗效果。结果通气组BiPAP治疗后pH、PaO2较治疗前及对照组治疗后显著提高,PaCO2等则显著下降。结论 BiPAP是治疗COPD合并Ⅱ型呼衰患者较好的治疗方法。     

Changes in respiratory and circulatory functions during sequential invasive- noninvasive mechanical ventilation

Objective To investigate the changes in respiratory and circulatory functions in chronic obstructive pulmonary disease (COPD) patients during sequential invasive-noninvasive mechanical ventilation therapy, and evaluate the effects of this new technique.Methods Twelve COPD patients with type Ⅱ respiratory failure due to severe pulmonary infection were ventilated through an endotracheal tube. When the pulmonary infection control window (PIC-Window) occurred, the patients were extubated and were ventilated with a facial mask using pressure support ventilation combined with positive end-expiratory pressure. The parameters of hemodynamics, oxygen dynamics, and esophageal pressure were measured at the PIC-Window during invasive mechanical ventilation, one hour after oxygen therapy via a naso-tube, and three hours after non-invasive mechanical ventilation.Results The variation in esophageal pressure was 20.0±6 cmH2O during naso-tube oxygen therapy, and this variation was higher than that during non-invasive mechanical ventilation (10±6 cmH2O, P&lt;0.01). The changes in respiratory and circulatory parameters were not significantly different between invasive mechanical ventilation and noninvasive mechanical ventilation (P&gt;0.05).Conclusions The respiratory and circulatory functions of COPD patients remained stable during sequential invasive-noninvasive mechanical ventilation therapy using PIC-Window as a switch point for early extubation. The COPD patients can tolerated the transition from invasive mechanical ventilation to noninvasive mechanical ventilation.     

无创正压通气治疗呼吸衰竭32例临床分析

无创正压通气(noninvasive positive pressure ventilation，NIPPV)指的是不需要建立有创人工气道，经鼻／面罩而进行的辅助机械通气。近年来NIPPV用于各种急性呼吸衰竭(acute respiratory failure，ARF)的治疗逐渐增多并占有重要地位。2002年2月-2004年8月我院ICU运用NIPPV技术治疗32例呼吸衰竭患者取得一些经验，现总结报告如下。     

Comparison of Noninvasive Positive Pressure Ventilation and Invasive Positive Pressure Ventilation in Patients with Acute Respiratory Failure

The use of noninvasive positive pressure ventilation (NPPV)in the treatment of acute respiratory failure (ARF) has been supported by a number of randomised controlled trials. We conducted a controlled prospective randomised study to compare the efficacy of NPPV with the efficacy of invasive positive pressure ventilation (IPPV) in ARF patients whose conditions had not improved under aggressive medical therapy thus requiring mechanical ventilation (MV).     

Effect of noninvasive, positive pressure ventilation on patients with severe, stable chronic obstructive pulmonary disease: a meta-analysis

Background This meta-analysis evaluated the effect of noninvasive,positive pressure ventilation on severe,stable chronic obstructive pulmonary disease (COPD).Methods PUBMED,CNKI,Wanfang,EMBASE and the ...     

无创通气在治疗胸心外科急性呼吸衰竭患者中的运用

目的:比较无创正压通气(Noninvasive positive pressure ventilation,NPPV)和有创正压通气(Invasive positive pressureventilation,IPPV)在胸心外科救治急性呼吸衰竭(Acute respiratory failure,ARF)的临床效果,...     

无创正压通气治疗慢阻肺并呼吸衰竭46例的护理

无创正压通气（noninvasive positive pressure ventilation，NIPPV）是近年来呼吸衰竭（以下简称呼衰）治疗的重要进展，可用于治疗不同病因引起的呼衰，尤其是对慢性阻塞性肺疾病（chronic obstructive pulmonary disease，COPD）合并呼衰的治疗。我院于2004年4月～2005年10月在吸氧、抗感染、止咳、平喘等常规治疗的基础上应用NIPPV治疗COPD合并呼衰46例，疗效显著，现总结如下：     

无创正压通气对慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者尿量的影响

目的 观察无创正压通气治疗对慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者尿量的影响.方法 2007年1月至2008年8月入住我科的慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者55例,均给予氧疗、抗感染、化痰、扩张气道治疗.除上述治疗外,其中19例(A组)接受无创正压通气治疗每天16 h以上;16例(B组)给予口服利尿剂氢氯噻嗪25 mg/d加螺内酯40 mg/d(B组);其余20例(C组)患者未接受无创正压通气或口服利尿剂.观察入选患者住院期间尿量,计算出每例患者的日平均尿量并做记录(单位ml/24 h).将三组记录作比较.结果 A组尿量为(1972±110)ml/24 h,B组为(1750±125)ml/24 h,C组为(1408±117)ml/24 h,三组结果相比差异有统计学意义(P＜0.01).结论 无创正压通气治疗能明显增加慢性阻塞性肺疾病致慢性肺源性心脏病合并全身水肿患者的尿量,达到减轻水肿的目的 ,较口服利尿剂效果更明显. Abstract： Objective To observe the effect of noninvasive positive pressure ventilation (NPPV)on urinary volume in patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary disease.Methods From January 2007 to August 2008,55 patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary disease were enrolled in this study.All patients received oxygen therapy,anti-infection,dissipate phlegm and to airway dilation,and they were randomly divided into three group. Patients in group A(19 cases)received noninvasive positive pressure ventilation for more than 16 hours per-day;Patients in group B(16 cases)were given hydrochlorothiazide 25 mg/d and spironolactone 40 mg/d.Patients in group C(20 cases) didn't received NPPV or oral diuretics.Observe urinary volume of all the enrdled patients,and daily mean urinary volume of each patient was calculated and recorded(ml/24 hour).Compare the records between three groups.Results The wrinary volume in group A was(1972±110)ml/24 h,(1750±125)ml/24 h in group B and(1408±117)ml/24 h in group C.There were significant differences between the three groups(P＜0.01).Conclusions NPPV may increase urinary volume obviously of the patients with chronic cor pulmonale combined with general dropsy caused by chronic obstructive pulmonary diseaes,so can lessen edema,and the effect is more obvious than oral diuretic.     

压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期35例疗效观察

目的 探讨压缩雾化吸入可必特对慢性阻塞性肺疾病急性加重期的疗效和不良反应.方法 将75例患者随机分为两组,对照组30例采用常规治疗,治疗组35例在常规治疗基础上加用雾化治疗,观察两组治疗效果和解除主要症状、体征的时间和住院时间.结果 治疗组住院时间和喘憋、肺部喘鸣音的持续时间均明显短于对照组(P＜0.05).结论 压缩雾化吸入可必特治疗慢性阻塞性肺疾病急性加重期疗效确切,方法简便,不良反应小,值得推广. Abstract： Objective To explore the effect of compressed nebulized inhalation combivent on chronic obstructive pulmonary disease with acute exacerbation. Mehods Seventy-five patients were randomly divided into two groups,the control group(30 cases) with conventional treatment, the treatment group (35 cases) on the basis of conventional therapy plus treatment with the spray were observed lifting of the main symptoms and signs of the time and hospital stay.Results The treatment group hospitalization time and asthmatic lungs duration of wheezing were significantly shorter than the control group (P<0.01). Conclusions Compression combivent aerosol inhalation treatment of chronic obstructive pulmonary disease with acute exacerbation is simple, side effects are little and are worth promoting.     

无创呼吸机治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭的临床观察

目的:探讨无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭的临床效果。方法:选择慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者60例,将上述患者分为观察组和对照组。对照组采用常规治疗,观察组在常规治疗基础上实施无创机械通气治疗。结果:观察组治疗后呼吸频率、心率、pH值、PaO2、PaCO2分别与对照组治疗后比较,差异有统计学意义(P<0.05)。结论:无创机械通气能够显著改善慢性阻塞性肺病合并呼吸衰竭患者临床症状,临床效果显著。     

吸入沙美特罗/氟替卡松联合噻托溴铵对稳定期慢性阻塞性肺疾病患者的疗效观察

目的 观察长期吸入沙美特罗/氟替卡松及噻托溴铵治疗稳定期慢性阻塞性肺疾病(COPD)患者的疗效.方法 将95例稳定期COPD患者随机分为三组:A组吸入沙美特罗/氟替卡松和噻托溴铵;B组吸入沙美特罗/氟替卡松;C组吸入噻托溴铵.治疗半年,评估肺功能1秒钟用力呼气容积(FEV1)、FEV1与用力肺活量的比值与治疗满意度.疗效比较采用优势检验.结果 全部病例完成半年随访,吸入沙美特罗/氟替卡松和噻托溴铵可明显减缓肺功能的恶化,同时发现吸入沙美特罗/氟替卡松和噻托溴铵组有着明显的治疗满意度.结论 吸入沙美特罗/氟替卡松和噻托溴铵在改善症状方面优于噻托溴铵,具有较好的依从性. Abstract： Objective To observe therapeutic effects of inhaling salmeterol/fluticasone and tiotropium bromide for stable COPD patients. Methods Ninety-five cases of stable COPD patients were divided randomly into three groups, group A inhaling salmeterol/fluticasone and tiotropium bromide, group B inhaling salmeterol/fluticasone, group C inhaling tiotropium bromide. All were for half a year. Lung function(FEV1,FEV1/FVC) and AECOPD manifestations and therapeutic satisfaction were evaluated. Therapeutic effects were compared with advantage test. Results All follow-ups of half a year were completed. It was found that inhaling salmeterol/fluticasone and tiotropium bromide could decrease obviously worsening of lung function. And meanwhile there was more satisfactory therapy than another two groups.Conclusions Inhaling salmeterol/fluticasone is better than inhaling tiotropium bromide in improving symptoms and with better compliance.     

慢性阻塞性肺疾病患者血清瘦素水平与炎性反应相关性

目的 探讨慢性阻塞性肺疾病(COPD)患者血清瘦素水平变化及其与炎性反应的关系,了解瘦素在COPD患者炎症反应过程中的作用及其意义.方法 选择COPD患者共58例,COPD急性加重期(Ⅰ组)30例,COPD缓解期(Ⅱ组)28例,正常对照组28例.测定和计算各组的多项营养指标,包括身高、体重、体重指数(BMI)、理想体重百分比(NM%)、体脂百分比(fat%).用酶联免疫吸附试验法(ELISA)测定58例COPD患者和28例正常人的血清瘦素、肿瘤坏死因子-α(TNF-α)、白细胞介素-8(IL-8)、超敏C-反应蛋白(hs-CRP)水平及肺功能,分析瘦素与各项参数的相关性.结果 ①COPD患者的各营养指标:BMI、NM%、fat%均显著低于正常对照组(P<0.01).②COPD I组血清瘦素、TNF-α、IL-8、hs-CRP均显著高于正常组与COPDⅡ组(P<0.01);COPDⅡ组血清瘦素低于正常组(P<0.01),TNF-α、IL-8、hs -CRP高于对照组(P<0.01);③COPD患者的瘦素含量与BMI、NM%、fat%、TNF-α、IL-8、hs -CRP水平显著正相关.结论 血清瘦素在COPD急性加重期明显高于缓解期,并与营养参数、TNF-α、IL-8、hs -CRP呈显著正相关,提示瘦素可能与COPD的疾病本身和全身炎症反应有关,可作为COPD急性加重期的炎症标志物. Abstract： Objective To investigate the expression and significance of serum leptin in patients with chronic obstructive pulmonary disease(COPD). Methods Thirty COPD patients in acute exacerbations phase (group I), 28 COPD patients in stationary phase(group Ⅱ) and 28 healthy controls were studied. Body height, body mass,body mass index (BMI), percentage of normal body mass (NM%), percentage of body fat(fat%) were determined.The serum leptin、TNF-α、IL-8、hs-CRP levels were examined by ELISA. The correlation between leptin and other parameters was analysed. Results ①BMI,NM% fat% in COPD patients significantly lower than those in healthy controls (P<0.01). ②Serum leptin、TNF-α、IL-8、hs-CRP level was significantly higher in group I than that in healthy controls and in group II (P<0.01); Serum leptin level was significantly lower in group II than that in healthy controls (P<0.01); Serum TNF-α、IL-8、hs-CRP level was higher in healthy controls (P<0.01). ③The leptin level was associated positively with BMI,NM%, fat%. TNF-α、IL-8、hs-CRP level of COPD. Conclusions The leptin level of COPD in acute is higher than that in stationary, and the levels were correlated to nutritional parameters,TNF-α,IL-8,hs-CRP.The result suggests that leptin may play a role in systemic inflamination of COPD, the leptin is an inflaming mark of the actue exacerbation phase in patients with COPD.     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察

目的:探讨无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效。方法:将96例急性发作的慢性阻塞性肺疾病(COPD)呼吸衰竭患者作为研究对象,分为对照组与观察组,对照组患者进行常规治疗,观察组患者在对照组基础上进行无创通气治疗,比较两组患者的呼吸、心率、血气变化及不良反应、插管情况。结果:观察组患者的呼吸、心率、血气变化及插管均显著优于对照组,观察组患者的不良反应情况均经对症治疗后获得缓解。结论:无创呼吸机可有效治疗慢性肺疾病合并呼吸衰竭。     

阿托伐他汀对冠心病合并充血性心力衰竭患者血管内皮功能的影响

目的 研究阿托伐他汀对冠心病(CHD)合并充血性心力衰竭(CHF)患者血浆中一氧化氮(NO)、降钙素基因相关肽(CGRP)和内皮素(ET)的影响.方法 将68例CHD并CHF患者随机分为两组,常规治疗组(地高辛、氢氯噻嗪、硝酸异山梨酯)34例,联用组常规用药加阿托伐他汀34例,另选34例健康体健者为正常对照组.采用Greiss法测定NO水平,放射性免疫法测定治疗前后血中CGRP和ET的水平.结果 CHD并CHF患者中NO和CGRP水平明显低于正常组(P＜0.01),ET显著高于正常组(P＜0.01),治疗后均显著改善(P＜0.01),且以联用组改善更为显著,与常规组治疗后比较差异有统计学意义(P＜0.05).结论 常规用药加阿托伐他汀能显著改善CHD合并CHF患者的NO、CGRP和ET的代谢失衡. Abstract： Objective To study the effect on levels of plasma calcitonin gene-related peptide (CGRP) and endothelin(ET) of atorvastatin in patients with coronary artery heart disease(CHD) complicated with congestive heart failure(CHF). Methods Patients with CHD complicated with CHF were divided into two groups usual medicine group(usual medicine) and atorvastatin group. The plasma CGRP and ET levels were observed before and after treatment. Results The levels of CGRP in patients with CHF were lower than that in normal group before treatment (P＜0.05),and the level of ET was higher (P＜0.05),the improvement of CGRP and ET in atorvastatin group was better than that in the usual medicine group(P＜0.05). Conclusions Atorvastatin had the action of improving the imbalance of CGRP and ET in Patients with CHD complicated with CHF.     

Noninvasive positive-pressure ventilation in acute respiratory failure

Noninvasive positive-pressure ventilation is a type of mechanical ventilation that does not require an artificial airway. Studies published in the 1990s that evaluated the efficacy of this technique for the treatment of diseases as chronic obstructive pulmonary disease, congestive heart failure and acute respiratory failure have generalized its use in recent years. Important issues include the selection of the ventilation interface and the type of ventilator. Currently available interfaces include nasal, oronasal and facial masks, mouthpieces and helmets. Comparisons of the available interfaces have not shown one to be clearly superior. Both critical care ventilators and portable ventilators can be used for noninvasive positive-pressure ventilation; however, the choice of ventilator type depends on the patient's condition and therapeutic requirements and on the expertise of the attending staff and the location of care. The best results (decreased need for intubation and decreased mortality) have been reported among patients with exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary edema.     

骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响

目的 探讨骶管阻滞复合全麻喉罩通气对小儿血液动力学的影响.方法 择期下腹部、会阴部或下肢手术小儿60例,ASA I或II级.随机分为单纯气管插管组(T组),骶管阻滞复合气管插管组(CT组),骶管阻滞复合喉罩通气组(CL组),每组20例.分别于诱导前(T0)、插管即刻(T1)、手术开始(T2)、手术开始后30 min(T3)、手术开始后60 min(T4)监测心率(HR)、血压、脉搏氧饱和度、呼气末CO2分压,记录平均动脉压(MAP),中心静脉压,丙泊酚、瑞芬太尼的用量及术后不良反应的发生情况.结果 T组、CT组在T1时点MAP、HR明显高于CL组(P<0.05);CL组、CT组丙泊酚及瑞芬太尼的用量明显少于T组;CL组术后不良反应最少.结论 骶管阻滞复合全麻喉罩通气对小儿的血液动力学影响最小,不良反应少. Abstract： Objective To investigate the effects of caudal block with laryngeal mask airway(LMA) ventilation on the hemodynamics of children undergoing elective surgery under general anesthesia. Methods Sixty ASA Ⅰ or Ⅱ children undergoing selective lower abdominal surgery were randomly divided into 3 groups (n=20):Group T:endotracheal intubation. Group CT:caudal block and endotracheal intubatio. Group CL:caudal block and laryngeal mask airway(LMA) ventilation. HR,BP,MAP,CVP,SpO2,PetCO2 were monitored during anesthesia.HR,MAP,CVP were recorded at proinduction (T0),intubation(T1),operation(T2),30 min after operation(T3) and 60 min after operation (T4).Recording the dosage of propofol,remifentanil and adverse reactions of postoperation. Results MAP,HR at T1 were significantly higher in group T and group CT than that in group CL.The dosage of propofol and remifentanil were significantly less in group CT and group CL than that in group T. Conclusions Caudal block with LMA ventilation have little side effects on hemodynamics of the children undergoing slective surgery with general anesthesia.