无创与有创机械通气治疗急性肺挫伤36例分析

目的：探讨无创或有创机械通气治疗急性肺挫伤的治疗时机。方法：对2001—01／2007—12急性肺挫伤36例患者根据临床指征选用无创或有创机械通气。结果：本组治愈34例，2例因多发伤并发多器官功能障碍综合征而死亡。治愈率为97％。结论：急性肺挫伤患者应及时给予气管插管或气管切开，行无创或有创呼吸机辅助通气，是提高治愈率、降低并发症的发生率及病死率的重要措施。     

无创正压通气的临床应用及其进展

机械通气是抢救呼吸衰竭、心力衰竭等危重病患者重要手段之一。传统意义上的机械通气是指有创通气，是通过气管插管连接患者与呼吸机，这种连接方式能确保机械通气的效果，但同时也造成了气道损伤、脱机困难，患者耐受性差等缺点。近年来，通过鼻罩或面罩连接呼吸机和患者的无创正压通气（noninvasive positive pressure ventilation，NPPV）技术得到广泛使用，并成为慢性阻塞性肺疾病（c0PD）急性加重期、急性肺损伤（ALI）、急性呼吸窘迫综合征（ARDS）、急性心源性肺水肿、重症哮喘等所致急性呼吸衰竭的重要呼吸支持手段。本文介绍NPPV的作用原理与适应证，阐述实施NPPV必要的技术要求及常见并发症的处理，综述如下。     

早期ARDS应用无创通气的临床观察

目的：总结早期ARDS应用无创通气的治疗效果及注意事项。方法：将38例早期ARDS患者随机分成试验组和对照组，试验组19倒应用无创通气，对照组19例应用有创通气，两组均在通气后1，5，10，20h做血气分析，观察两组患者相同时间的氧舍状态、血流动力学、并发症等。结果：早期ARDS使用无创通气与有创通气在血流动力学上差异无统计学意义（P〉0．05）。结论：使用无创通气治疗早期ARDS有效地改善了患者的舒适感，保留了上呼吸道的防御功能，避免了气管插管相关的并发症。     

有创与无创序贯性机械通气在救治COPD并急性呼吸衰竭中的应用与护理

近年来,国内外对从有创机械通气过渡到无创通气的研究较多,如何更合理、更有效地使用序贯机械通气,是治疗慢性阻塞性肺疾病并急性呼吸衰竭的重要课题。我们通过有创-无创序贯性机械通气抢救慢性阻塞性肺疾病并急性呼吸衰竭患者24例,取得了较好效果,现报道如下。资料与方法1.一般资料。2001年6月-2004年12月,我院因COPD急性发作、支气管-肺部感染加重、合并急性呼吸衰竭和肺性脑病而收入我院呼吸重症监护室(RICU)45例患者,经过解痉、平喘、祛痰、抗感染、给氧、支持治疗及经无创通气治疗无效,均符合Brochhard气管插管指征[1]。诊断标准均…     

无创机械通气治疗急性呼吸衰竭的观察与护理

在无气管插管或气管切开的情况下应用机械通气,可为自主呼吸存在的患者提供通气支持称为无创机械通气(NIV).该技术广泛应用于临床抢救急性呼吸衰竭(ARF)患者,并取得了较好的疗效,同时避免了许多由于气管插管或气管切开引起的问题[1].     

经鼻高流量氧疗和无创正压通气对于肺源性中重度急性呼吸窘迫综合征患者初始治疗的效果评价

目的:对比及评价经鼻高流量氧疗(HFNC)和无创正压通气(NPPV)对于肺源性中重度急性呼吸窘迫综合征(ARDS)患者的初始治疗效果。方法:采用回顾观察性研究,选择2016-01-01—2018-08-01期间因肺源性中重度ARDS入住我院急诊ICU的患者,且给予常规氧疗后低氧不能缓解。根据患者入院后最高的无创氧疗方案将患者分为经鼻高流量(HFNC)组及无创通气(NPPV)组,所有患者的无创氧疗方案选择为随机进行。主要观察指标为90 d病死率,次要观察指标为患者28 d气管插管率。结果:41例患者纳入分析,患者来自中国11个省,入院原因均为重症肺炎,入住ICU时氧合指数(PaO_2/FiO_2)均≤200 mmHg。所有患者的90 d病死率为49%(20/41),28 d气管插管率为51%(21/41)。HFNC组26例患者,90 d病死率为42%(11/26),28 d气管插管率为42%(11/26);NPPV组15例患者,90 d病死率为60%(9/15),28 d气管插管率为67%(10/15)。HFNC组和NPPV组90 d病死率及28 d气管插管率差异无统计学意义。根据患者基础免疫功能将所有患者分为非免疫抑制患者及免疫抑制患者,非免疫抑制患者共23例,其中HFNC组14例,NPPV组9例,HFNC非免疫抑制组患者90 d病死率及28 d插管率显著低于NPPV组患者(14%vs.67%,P=0.008;14%vs.67%,P=0.01)。免疫抑制患者共18例,其中HFNC组12例,NPPV组6例,使用HFNC患者的90 d病死率及28 d插管率与NPPV组患者差异无统计学意义(75%vs.50%,P=0.46;75%vs.67%,P=0.71)。结论:与NPPV比较,对于非免疫抑制肺源性中重度ARDS患者采用HFNC初始治疗可显著降低病死率及气管插管率,是一种较为理想的无创氧疗方案。     

无创正压通气治疗高碳酸血症急性呼吸衰竭疗效评价

目的：研究无创正压通气治疗高碳酸血症急性呼吸衰竭的临床疗效。方法：对36例高碳酸血症急性呼吸衰竭患者进行无创正压通气治疗，观察临床症状改善、血气指标变化、住院天数、气管插管率和痛死率。并同以往未使用无创正压通气治疗的38例相似病例进行比较。结果：无创正压通气治疗组治疗后2h,24h临床症状改善，血气指标改善，住院天数缩短，气管插管率、痛死率降低。与对照组相比差异有显著意义。结论：无创正压通气治疗高碳酸血症急性呼吸衰竭安全、有效。     

无创通气在急性左心衰合并低氧血症患者抢救中的临床价值

目的：评价无创机械通气在急性左心衰竭合并低氧血症抢救中的临床价值。方法：对28例急性左心衰合并低氧血症的患者在常规内科治疗同时加用无创性经面罩机械通气（NIV）治疗，观察无创通气（NIV）前后患者呼吸指标、肺气体交换与心率（HR）、平均动脉压（MAP）的变化。结果：28例患者均能耐受NIV治疗，无一例需要气管插管机械通气，临床症状明显改善，呼吸频率明显下降（P〈0．05）。与NIV治疗前相比，患者的动脉血中pH、氧分压（PaO2）、二氧化碳分压（PaCO2）、氧饱和度（SaO2）等指标明显改善，HR与MAP明显减慢（P〈0．05）。结论：经面罩NIV治疗急性左心衰时能迅速改善患者的症状和低氧血症，避免气管插管，是一种快速、安全、有效的方法。     

经鼻罩机械通气治疗重度支气管哮喘急性发作（附42例报告）

支气管哮喘急性发作如不及时有效治疗可导致呼吸衰竭，危及生命。对于重度支气管哮喘急性发作，人工通气是抢救、治疗的重要方法，有创人工通气需要气管插管或气管切开。这给患者带来一定程度的痛苦，并需要特别的护理，且医疗费用高，无创机械通气正成为呼衰患者第一线治疗手段，为呼衰的及时抢救预防和康复创造了条件。近8年来     

急性肺水肿的常规药物治疗和机械通气治疗20例分析

目的：探讨急性肺水肿（APE）的特点及救治措施。方法：回顾性分析20例急性APE患者的临床资料,及对在常规药物治疗基础上使用机械通气治疗纠正呼吸衰竭的疗效分析。结果：20例患者18例抢救成功（90%）,2例死亡（10%）。结论：机械通气治疗肺水肿安全有效,早期予以合理的机械通气治疗尤其是无创机械通气治疗,尽量避免气管插管,减少插管带来的并发症,提高抢救成功率,降低住院费用。     

无创正压通气治疗创伤性湿肺的临床研究

目的 观察无创正压通气（NIPPV）治疗创伤性湿肺的疗效。方法 选择30例行无创正压通气治疗的创伤性湿肺患者为治疗组，24例未用NIPPV治疗的创伤性湿肺患者为对照组，通过对2组患者进行心电监测、血氧饱和度、呼吸频率、血气分析等指标的监测，比较2组患者呼吸频率和动脉血气参数、肺部病变吸收时间、气管插管率、ICU住院时间及预后。结果 30例创伤性湿肺患者经NIPPV治疗后动脉血气指标与临床表现明显改善（P〈0．01）；与对照组相比，NIPPV治疗组患者临床症状改善时间、肺部病变吸收时间、ICU住院时间明显缩短（P〈0．01），肺实变率显著减低（P〈0．05），但2组患者气管插管率和病死率差异却无显著性。结论 NIPPV通过调节压力支持与呼吸末正压水平，早期应用可明显改善创伤性湿肺患者病情及缩短病程，但并不能改善其预后。     

无创正压通气治疗急性呼吸窘迫综合征的研究

目的：探讨无创正压通气(NIPPV)治疗急性呼吸窘迫综合征(ARDS)改善疗效的因素。方法：23例ARDS患者按诱发因素分为肺内因素组(A组)和肺外因素组(B组)。选择不同呼吸机和鼻(面)罩行NIPPV，采用双相压力支持通气(BiPAP)；多功能呼吸机采用压力支持通气(PSV) 呼气末正压(PEEP)或同步间歇指令通气(SIMV) PSV PEEP。通气3—10h，不适合NIPPV的患者改建人工气道通气。结果：全程进行NIPPV治疗的患者A组5例，B组12例；NIPPV治愈A组为55．6％(5／9)；B组为85．7％(12／14)，P＜0．05。结论：选择合适的适应证，合理选择呼吸机、呼吸模式和治疗参数，并改善对NIPPV不利的影响因素，可以减少人工气道的使用。     

Does noninvasive ventilation work in ARDS? A case report and review of the current literature

The role of noninvasive positive pressure ventilation (NIPPV) in adult respiratory distress syndrome (ARDS) is controversial, in contrast to its well established benefits in other types of respiratory failure, especially acute exacerbations of chronic obstructive pulmonary disease and cardiogenic pulmonary oedema. We report a case of ARDS caused by Mycoplasma pneumoniae in a 70 year old man, treated with NIPPV in addition to standard medical therapy and analyse current evidence regarding the role of NIPPV in patients with ARDS.     

无创正压通气与有创通气治疗淹溺者并急性呼吸窘迫综合征的疗效比较

目的观察比较无创正压通气与有创通气治疗淹溺者并急性呼吸窘迫综合征的治疗效果。方法63例淹溺并急性呼吸窘迫综合征患者随机分为A、B两组,A组为无创正压通气组,B组为有创通气组,分别给予无创正压通气治疗和有创通气治疗,观察两种通气方法的治疗效果。结果与治疗前比较机械通气0．5h、1h,4h、12h后两组pH、Pa02、PaCO2及HR、RR均明显改善（P〈0．05）。B组HR、RR在机械通气0．5h、1h后下降较A组快,但在机械通气4h后两组HR、RR变化一致。这与B组气管插管时应用镇静麻醉剂或肌肉松弛剂有关。A组机械通气时间、总住院时间均短于B组（P〈0．05）,A组平均住院费用、呼吸机相关肺炎发生率少于B组（P〈0．05）,治愈率两组无明显差别。结论无创正压通气方法和有创通气方法治疗淹溺者并急性呼吸窘迫综合征均有较好的治疗效果,无创正压通气方法优于有创通气方法。     

SARS危重患者无创正压通气并发症分析及呼吸治疗策略的探讨

目的　对严重急性呼吸综合征 (SARS)危重患者行无创正压通气 (NIPPV)后出现气胸或纵隔气肿的临床资料进行分析 ,并探讨相应的呼吸治疗策略。方法　回顾性分析 2 7例行 NIPPV的 SARS危重患者的临床资料。结果　 2 7例行 NIPPV的 SARS危重患者中 ,有 7例出现气胸或纵隔气肿 ;189例未行机械通气的 SARS患者中 1例出现纵隔气肿 ;与后者比较 ,行 NIPPV的 SARS危重患者气胸或纵隔气肿发生率有非常显著性差异 (χ2 =2 5 .0 5 2 ,P<0 .0 1)。调整通气压力并适当提高吸入氧浓度后 ,所有患者脉搏容积血氧饱和度均无明显变化。 7例患者气胸或纵隔气肿均未进一步发展且逐步好转。结论　 SARS危重患者行 NIPPV后所出现气胸或纵隔气肿现象 ,可能与 SARS造成肺脏损伤、剧烈咳嗽及机械通气压力过高有关。对 SARS危重患者行 NIPPV治疗时谋求改善低氧血症的同时 ,还应该选择最佳的通气压力 ,以避免气胸或纵隔气肿的发生。     

Noninvasive ventilation in the intensive care unit -- is it still negligible?

Non-invasive positive pressure ventilation (NIPPV) has been discussed comprehensively in the last years, but usage of non-invasive ventilation in Intensive Care Units is rare. The reasons may be uncertainty in indications and difficulties in handling the masks and ventilators. In the last years the introduction of full face masks and respiratory helmets has made it possible to ventilate patients with unusual facial forms and to avoid problems of pressure necrosis. Software components designed for NIPPV are available for standard respirators. Indications for NIPPV (neuromuscular diseases, spinal abnormalities, chest wall malformations, COPD, cardiogenic pulmonary edema) have been ensured in clinical trials. No sufficient data are available for the application of NIPPV in weaning and respiratory failure following extubation. Indication for NIPPV becomes apparent when therapy starts in early stage with sufficient ventilation pressure. Compared to standard therapy, no reliable advantage has been seen for NIPPV in hypoxic hypercapnia respiratory failure except for malignant diseases. However, prophylactic use in patients with high risk might be conceivable. For these patients strict criteria of termination are required to avoid missing the time point for intubation. Gas exchange disturbances in advanced lung fibrosis, pneumonia and ARDS are not amenable to NIPPV. Contraindications for NIPPV are non-compliant patients, absence of cough- and pharyngeal reflexes as well as retention of secretions and malignant ventricular arrhythmia. Relative contraindications are catecholamine-dependent circulatory collapse and acute myocardial infarction, since sufficient data for NIPPV are missing.     

Non-invasive modalities of positive pressure ventilation improve the outcome of acute exacerbations in COLD patients

Objective 1) To compare the clinical usefulness of both non-invasive pressure support ventilation (NPSV) and non-invasive intermittent positive pressure ventilation in assist-control (A/C) mode (NIPPV) in chronic obstructive lung disease (COLD) patients with acute hypercapnic respiratory failure: 2) to compare retrospectively the usefulness of non-invasive mechanical ventilation (NMV) with standard medical therapy alone.Design Prospective randomized retrospective study.Setting 2 Respiratory intermediate intensive units.Patients 29 COLD patients (age: 62±8 years) with chronic respiratory failure were hospitalized in a department for rehabilitation during acute relapses of their disease. They were transferred to our intermediate intensive care unit (IICU) and submitted randomly to either NPSV (16 patients) or NIPPV (13 patients).Measurements and results Blood gas analysis, dynamic flows, clinical variables, success rate, time of ventilation, side effects and subjective score of compliance to therapy. Therapy was considered successful when endotracheal intubation was avoided and patients were returned to their condition prior to exacerbation. No statistically significant difference was found between NPSV and NIPPV in success rate (NPSV 87.5%; NIPPV 57%) or in time of ventilation (NPSV: 69±49; NIPPV: 57±49 h). A better compliance to non-invasive mechanical ventilation (NMV) was found in NPSV patients than in NIPPV patients; side effects were observed less frequently in the NPSV group. Comparison of the success rate of NMV was retrospectively performed with 35 control COLD patients with chronic respiratory insufficiency who had undergone an acute relapse of their disease in the 2 years preceding the institution of the IICU and had been treated with oxygen and medical therapy alone. Patients submitted to NMV showed a greater success rate than control (82 versus 54%) after a period of ventilation ranging from 4–216 h.Conclusion Non-invasive mechanical ventilation performed either by NPSV or NIPPV may improve the outcome of acute exacerbations of COLD, as compared to medical therapy alone. NPSV seems to be more acceptable to patients in comparison with NIPPV.     

Noninvasive ventilation in respiratory failure due to cystic fibrosis

BACKGROUND: Noninvasive positive-pressure ventilation (NIPPV) is increasingly used as an effective means of avoiding endotracheal intubation and mechanical ventilation in patients with respiratory insufficiency or failure. METHODS: We retrospectively reviewed our experience with NIPPV to treat respiratory failure in five patients with cystic fibrosis (CF). RESULTS: Despite chronic lung disease related to CF, none of our cases were end-stage. All patients had recent pulmonary function tests showing a forced expiratory volume in 1 second (FEV1) of more than 30% predicted for age. All patients had progressive atelectasis, hypoxemia, and impending respiratory failure related to an acute pulmonary exacerbation or upper abdominal surgical procedure (open gastrostomy tube placement). Respiratory rates decreased, oxygen saturation increased, fraction of inspired oxygen (FiO2) requirement decreased, transcutaneous CO2 decreased, and atelectasis resolved with NIPPV. CONCLUSIONS: Use of NIPPV provides effective respiratory support while avoiding the need for endotracheal intubation. The applications of NIPPV, reports of its use in patients with CF, and the equipment required are reviewed.     

无创正压通气治疗急性心源性肺水肿36例

目的 评价无创正压通气治疗急性心源性肺水肿的疗效。方法 选择36例急性心源性肺水肿患者，在高流量吸氧及常规药物治疗不能纠正缺氧时，经面罩给予无创正压通气，观察治疗前、治疗后0．5h、1h、2h后临床症状、体征和动脉血气分析的变化。结果 经面罩无创正压通气治疗后，36例患者中32例（88．89％）临床症状、体征明显改善，血气分析中PaO2明显升高（P〈0．01）、PaCO2有所下降（P〈0．05），避免了进一步有创机械通气治疗带来的损伤和经济负担；4例（11．11％）经无创正压通气治疗无效，改为经口气管插管机械通气；死亡2例。结论 应用无创正压通气可明显改善急性心源性肺水肿患者的症状、体征和血气分析结果，可作为急性心源性肺水肿安全、快速、有效的治疗手段之一。     

综合护理干预对COPD合并Ⅱ型呼吸衰竭患者无创正压通气治疗效果的影响

目的:探讨综合护理干预对慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者无创正压通气(NIPPV)治疗效果的影响。方法:将96例COPD合并Ⅱ型呼吸衰竭患者按照格拉斯哥昏迷评分(GCS)分为两组,GCS≤8分34例为昏迷组,GCS>8分62例为对照组。比较两组在综合护理干预下NIPPV治疗后的转归和治疗前后动脉血pH值、氧合指数(PaO2/FiO2)、PaCO2。结果:两组治疗后APACHEⅡ分值、呼气压力(EPAP)设定值、通气时间、住院时间、治疗成功率、有创通气比例、病死率比较差异均无统计学意义(P>0.05),而两组吸气压力(IPAP)设定值比较差异有统计学意义(P<0.01)。两组经NIPPV治疗后2 h、24 h,动脉血pH值、PaO2/FiO2、PaCO2与治疗前比较差异均有统计学意义(P<0.05,P<0.01)。NIPPV治疗前,治疗失败者的APACHEⅡ值高于治疗成功者(P<0.05),而两者间的GCS比较差异无统计学意义(P>0.05);治疗2 h后,治疗成功者GCS高于治疗失败者,血气分析指标也比治疗失败者明显改善(P<0.05)。结论:在综合护理干预下,COPD合并Ⅱ型呼吸衰竭患者NIPPV治疗效果提高。