COPD合并急性呼衰患者从有创机械通气过渡至无创通气效果观察及时机探讨

目的　探讨慢性阻塞性肺疾病 (COPD)合并急性呼吸衰竭 (呼衰 )患者从有创机械通气过渡至无创通气的效果及时机。方法　将 2 8例 COPD合并急性呼吸衰竭且实施有创机械通气的患者当肺部感染基本控制时随机分为两组 ,各 14例。A组继续行有创通气 ,B组拔除气管插管改为面罩无创机械通气。观察两组呼吸机相关肺炎 (VAP)例数、病死例数、机械通气时间、住呼吸监护室 (RICU)时间。结果　 A组与 B组发生 VAP的例数分别为 8例和 1例 (P <0 .0 5 ) ;死亡例数分别为 2例和 1例 (P >0 .0 5 ) ;总机械通气时间分别为 (2 1± 9)天和 (11± 5 )天(P <0 .0 5 ) ;住 RICU时间分别为 (2 5± 10 )天和 (16± 7)天 (P <0 .0 5 )。结论　 COPD合并急性呼吸衰竭机械通气患者当肺部感染基本控制时改用无创通气可以降低 VAP发生率 ,缩短机械通气时间和住 RICU时间。     

机械通气治疗老年急性左心衰竭的初步经验

目的　探讨老年急性左心衰时机械通气的疗效及适应症。方法　 2 5例急性左心衰竭患者 ,予常规吸氧或高流量面罩吸氧及积极药物治疗同时 ,适时给予气管插管机械通气 ,并观察记录 1～ 2小时后患者重要生理参数改变 ,进行统计分析。结果　 2 3例 (92 % )患者病情迅速控制或好转 ,低氧血症及呼吸性酸中毒纠正。治疗后 1～ 2小时 ,血气分析PH、PaO2 、PaCO2 及SaO2 明显改善。分别为 [(7 12± 0 0 5 )vs(7 34± 0 0 2 ) ,P<0 0 0 1,(5 4 6± 13 1)vs(83 4± 2 0 9)mmHg,P <0 0 0 1,(95 5± 18 3)vs(5 6 2± 2 0 9)mmHg ,P <0 0 0 1,(6 5 5±3 1)vs(92 6± 5 7) % ,P± <0 0 0 1]。平均血压无明显改变 [(91 6± 2 1 0 )vs(92 5± 17 7)mmHg ,P >0 0 5 ],心率明显改善。 [(116± 18 6 )vs(10 2± 12 8)次 /分 ,P <0 0 0 1]。结论　老年急性左心衰竭患者 ,在适当时机辅以机械通气是提高抢救成功率的一种有益手段     

单纯氧疗与持续气道正压通气对慢性充血性心力衰竭Cheyne-Stokes呼吸的作用

目的观察并比较单纯氧疗与经鼻持续气道正压(nCPAP)通气对稳定期慢性充血性心力衰竭(CHF)患者Cheyne-Stokes呼吸的影响及疗效。方法采用前瞻、随机、交叉对照性设计。对入选患者测左室射血分数(LVEF),同时采用多导睡眠图证实是否存在Cheyne-Stokes呼吸,对存在Cheyne-Stokes呼吸者随机交叉进行整夜单纯鼻导管给氧(2L/min和4L/min)及nCPAP通气治疗[平均压力为(9·1±1·1)cmH2O]。结果共入选26例稳定期CHF患者,其中14例(53·8%)存在Cheyne-Stokes呼吸,呼吸暂停低通气指数(AHI)为(34·9±8·2)次/h,夜间最低动脉血氧饱和度(SaO2)为(76·2±4·7)%,SaO2<90%的时间占总睡眠时间百分比为(20·9±8·6)%,平均呼吸暂停低通气时间为(20·6±3·2)s,循环长度为(74·8±21·3)s,循环时间为(25·6±4·4)s。单纯鼻导管给氧(2L/min或4L/min)及nCPAP通气后,与基础状态相比,AHI降低,吸氧4L/min与nCPAP通气的效果优于吸氧2L/min;夜间最低SaO2升高;夜间SaO2<90%的时间占总睡眠时间百分比改善,以吸氧4L/min效果更佳;总睡眠时间增加,睡眠效率改善,但呼吸暂停低通气时间、循环长度及循环时间与基础状态比无明显改变。结论稳定期CHF患者Cheyne-Stokes呼吸的发生率很高,氧疗(4L/min)及nCPAP通气可作为治疗CHF患者Cheyne-Stokes呼吸的有效方法。     

严重急性呼吸综合征的正压通气治疗

重症严重急性呼吸综合征(SARS)患者,通常以急性缺氧性(Ⅰ型)呼吸衰竭为最主要的表现,也是最常见的死亡原因。如果经过常规氧疗等治疗后缺氧和呼吸困难不能缓解时,气道内正压机械通气是挽救生命的重要治疗措施。在广州达到确诊标准[1] 的6 4 1例SARS患者中,有无创正压通气患者15 9例(2 5 % ) ,其中4 2例(2 6 % )因病情加重而转为有创通气,2例(1% )没有转为有创通气而死亡,115例(72 % )康复出院;有创通气患者5 7例,包括无创正压通气转入者4 2例(74 % )和直接有创通气者15例(2 6 % ) ,死亡30例(5 3% )。一、正压通气的重要性正压通气是治疗…     

严重急性呼吸综合征所致呼吸衰竭及无创通气治疗

目的　回顾性总结严重急性呼吸综合征 (SARS)并发呼吸衰竭患者的血气特点 ,探讨应用无创正压通气 (NPPV)治疗的策略。方法　 2 0 0 3年 4月 2 2日～ 5月 1日 ,12 0例临床符合SARS诊断标准的患者入住北京地坛医院 (SARS专科医院 )的 4个病区 ,30例患者 (占 2 5 % )在病程中出现呼吸衰竭 ,达到急性肺损伤 (ALI)和 (或 )急性呼吸窘迫综合征 (ARDS)的诊断标准。 2 8例应用双水平气道正压通气 (BiPAP)。主要观察指标 :(1)住院期间的血气分析、脉搏容积血氧饱和度 (SpO2 )及呼吸频率 ,特别是上机前、上机后 1h及撤机后的结果 ;(2 )放射学检查或临床提示住院后新出现的气胸、纵隔气肿、心包积气及皮下气肿 ;(3)应用无创通气的天数 ;(4 )需气管插管行有创通气的患者数 ;(5 )患者的病死率 ;(6 )一线医务人员因护理治疗无创通气SARS患者而感染SARS的情况。结果统计 30例患者在整个病程中的动脉血二氧化碳分压 (PaCO2 )变化情况 ,16例 (5 3% )患者出现CO2 潴留 ,PaCO2为 4 5～ 5 6mmHg ,平均 (4 8± 4 )mmHg。NPPV治疗后动脉血氧分压 (PaO2 )、SpO2 、氧合指数及呼吸频率均显著改善 (P均 <0 0 1) ,但pH及PaCO2 的变化并不明显。 18例患者成功撤机 ,应用NPPV的时间为5～ 30d ,平均 (10± 6 )d。除 1例不能耐受BiPAP     

老年人阻塞性睡眠呼吸暂停综合征咽通道管的治疗

目的　评价老年人阻塞性睡眠呼吸暂停综合征 (OSAS)咽通道管治疗的应用价值。　方法　咽通道管治疗 30例老年OSAS患者 ,治疗前后用多导睡眠监测仪进行监测 ,其中 14例应用CT结合Muller试验检查咽腔变化。　结果　 (1) 30例老年OSAS患者中治疗前后呼吸暂停低通气指数(AHI)分别为 6 9 4± 18 1、2 9 5± 10 8,最低血氧饱和度 (LSaO2 )为 (5 9 3± 12 4) %、(81 2± 11 4) % ,睡眠时血氧饱和度超过 90 %的时间百分率 (MT90 )为 (6 7 3± 16 9) %、(92 0± 7 3) % ;(2 ) 14例行Muller试验者 ,腭咽、舌咽最小截面积分别为 (10 5± 11 0 )mm2 、(97 3± 2 6 5 )mm2 ,咽腔阻塞阳性率分别为92 9%、5 7 1% ;咽通道管治疗后腭咽、舌咽最小截面积分别为 (10 5 3± 4 6 )mm2 、(139 4± 2 8 2 )mm2 ,均无咽腔阻塞。　结论　咽通道管能改善老年OSAS患者咽腔阻塞 ,是治疗老年人OSAS的一种行之有效的方法     

重症急性呼吸综合征患者心肌损害的初步研究

目的　通过对重症急性呼吸综合征 (SARS)患者心肌酶变化的研究 ,探讨SARS患者的心肌损害及其临床意义。方法　依据广东省传染性非典型肺炎病例临床诊断标准 (草案 ) ,选择SARS患者 37例和健康体检者 35例 ,检测血清肌酸激酶、乳酸脱氢酶、AST、肌钙蛋白Ⅰ、肌酸激酶同工酶、肌红蛋白。结果　SARS组肌酸激酶、乳酸脱氢酶、AST(单位均为U/L)明显高于对照组 (分别为 2 85 4 9± 2 6 6 2 1比 10 6 71± 4 3 38;388 5 6± 198 80比 2 0 0 83± 4 4 86 ;71 0 3± 36 14比 2 9 4 3± 8 89,P值均 <0 0 1) ;死亡者均值较存活者高。SARS组肌钙蛋白Ⅰ、肌酸激酶同工酶、肌红蛋白阳性率高于对照组 ,P <0 0 5。病理显示心肌细胞局部变性。结论　SARS患者易合并心肌损害 ,临床收治该病患者时应予以足够的重视。密切监测心脏功能 ,对减少并发症、降低病死率具有重要意义。     

无创正压通气对心力衰竭合并睡眠呼吸暂停患者氨基端-脑钠肽前体水平的影响

目的观察无创正压通气对心力衰竭合并睡眠呼吸暂停患者血浆氨基端脑钠肽前体(NTproBNP)水平的影响。方法选符合标准的心力衰竭住院患者105例,摄X线胸片,行超声心动图检查及睡眠呼吸监测。凡入选干预治疗者随机分为常规药物治疗组(A组)和常规药物+正压通气治疗组(B组)。所有心衰患者及2组患者治疗前后取静脉血血浆,用竞争性酶联免疫吸附试验测NTproBNP水平。结果(1)105例心力衰竭患者中77例合并睡眠呼吸暂停,随着心功能分级的逐渐递增,NTproBNP水平亦逐渐增高(P<0.05)。(2)B组患者正压通气治疗2～5d后,AHI从(39.34±12.26)次/min降至(7.23±5.23)次/min(P<0.001);最低脉搏血氧饱和度(SpO2)从(73.27±4.75)%升至(83.12±3.86)%(P<0.001);B组患者治疗后NTproBNP水平有所下降(P=0.001);2组间NTproBNP变化比较差异有统计学意义(P=0.03)。结论NTproBNP水平能反映心力衰竭病情的严重程度,短期应用无创通气治疗心力衰竭合并睡眠呼吸暂停,能降低NTproBNP水平。     

无创机械通气对纠正低氧血症的临床观察

目的　探讨尽早应用无创机械通气以纠正低氧血症的技术可行性并评价其治疗效果。方法　选择接受无创机械通气的低氧血症病例 16例设为治疗组 ,以经鼻面罩压力支持通气 +呼气末正压通气 (PSV+PEEP) ,待低氧血症纠正后撤机 ;选择同期住院同样病情的低氧血症病例 16例接受简易面罩设为对照组 ,两组吸入氧浓度(Fi O2 )均为 4 1% ,观察 5分钟后血氧饱和度 (Sa O2 )及 30分钟后血气。结果　治疗组与对照组治疗前各项指标相仿(P>0 .0 5 )。给予面罩 5分钟后 Sa O2 分别为 94 .7± 5 .3和 81.1± 7.2 % ,P<0 .0 1;30分钟后氧合指数 331.2± 18.3和 2 2 0 .3± 14 .5 mm Hg,P<0 .0 5 ;Pa CO2 4 5 .6± 7.1和 6 1.7± 5 .6 mm Hg,P<0 .0 5。结论　因各种病因所致的低氧血症尽早使用经鼻面罩无创机械通气可明显纠正低氧血症 ,而对二氧化碳影响不显著     

78例传染性非典型肺炎病例临床分析

目的　分析传染性非典型肺炎 (世界卫生组织又称严重急性呼吸综合征 ,SARS)患者的临床特点 ,并对其诊断标准和治疗方法进行探讨。方法　对广州呼吸疾病研究所 2 0 0 2年 12月 2 2日至 2 0 0 3年 3月 31日收治的 78例SARS患者的临床、实验室、影像学资料进行回顾性分析。结果78例SARS患者 :男 4 2例 ,女 36例 ;年龄 2 0～ 75岁 ,平均 (37 5± 11 6 )岁 ;医务人员 4 4例 (5 6 % )。临床症状包括 :发热 (10 0 % )、咽痛 (17% )、咳嗽 (88% )、气促 (80 % )、畏寒 (5 9% )、肌肉酸痛 (41% )。血常规 :白细胞 (WBC) <4 0× 10 9/L 12例 (15 % ) ,WBC(4 0～ 10 0 )× 10 9/L 4 9例 (6 3% ) ,WBC >10 0× 10 9/L 17例 (2 2 % ) ,平均为 (7 6± 5 0 )× 10 9/L ;中性粒细胞为 0 75± 0 14 ,淋巴细胞 0 18±0 11。胸部X线和CT显示肺部斑片状阴影 ,短期内病灶增多 ,累计单侧 2 3例 (30 % )、双侧 5 2例(6 7% )。分析医护人员被感染途径 ,提示本病具有较强的飞沫近距离传染特性。出现急性肺损伤(ALI) 37例 (47% ) ,其中发展为急性呼吸窘迫综合征 (ARDS) 2 1例。 7例死亡患者均为ARDS合并有多器官功能衰竭综合征 (MODS)。结论　流行病接触史、发热、X线肺炎征及白细胞计数正常或减少是诊断本病的临床依据。     

Nichtinvasive Beatmung bei Patienten mit Lungenödem und akuter respiratorischer Insuffizienz

Noninvasive ventilation (NIV) is increasingly used in patients with acute respiratory insufficiency. NIV might mechanically support the ventilation of the patient and might therefore improve oxygenation, decrease hypercapnia, and correct respiratory acidosis. NIV has been successfully applied in patients with respiratory insufficiency due to acute cardiogenic pulmonary oedema. There is sufficient scientific evidence to use CPAP or bilevel ventilatory modes (pressure controlled ventilation, pressure support ventilation) as first-line treatment in these patients. The success rate of NIV is 60–75%. Predictors of NIV failure include greater severity of the underlying illness, lower level of consciousness, lower pH; more air leak around the mask, greater quantity of secretions, and the presence of pneumonia.     

106例重症急性呼吸综合征患者的临床特征与治疗总结

目的　了解重症急性呼吸综合征 (SARS)的临床特点以及探索临床有效的治疗方法。方法　用前瞻性的方法对入院的 10 6例SARS病例临床资料进行总结。结果　 10 6例患者男 5 6例 ,女5 0例 ;年龄 15～ 81岁 ,平均 (36± 10 )岁 ;多数病人都有发热 (98 1% )、畏寒 (75 5 % )、咳嗽 (71 7% )、头痛和胸闷憋气 (4 3 4 % )、腹泻 (2 4 5 % ) ,肺部有音者较少 (11 2 % )。WBC计数降低者占 34 0 % ,淋巴细胞计数减少者占 81 1% ,CD+ 4 T细胞减少者为 98 1% ,ALT增高者占 7 6 % ,血小板降低者少见(3 8% ) ;几乎所有病人在入院时或次日都有血氧分压下降 [<90mmHg(1mmHg =0 133kPa)者90 2 % ,<70mmHg者 2 8 6 % ];X线胸片表现为单侧局部肺部斑片状浸润者 34 0 % ,单侧多发肺部斑片状浸润者 11 3% ,双肺斑片状浸润者 4 6 2 %。临床治疗采取综合治疗的原则 ,包括以小剂量糖皮质激素 (甲泼尼龙 4 0～ 80mg,12h 1次 ) ,第二代头孢菌素、大环内酯类以及抗病毒药物为主 ,同时强调氧疗、对症及其基础病等的治疗。结论　SARS临床表现和实验室多样化 ,CD+ 4 T细胞测定有助于早期诊断 ,临床治疗以综合治疗为主 ,早期氧疗及小剂量激素治疗有较好的治疗效果。     

Severe acute respiratory syndrome in Taiwan: analysis of epidemiological characteristics in 29 cases

OBJECTIVES: To describe the clinical characteristics and outcomes of patients with severe acute respiratory syndrome (SARS). METHODS: Between March 28 and June 30 '2003, 29 patients with probable SARS seen at Shin Kong Wu Ho-Su Memorial Hospital, Taipei, were analysed. RESULTS: Presenting symptoms included fever (100%), cough (69.0%), chills or rigor (62.1%), and shortness of breath (41.4%). Mean days to defervescence were 6.8+/-2.9 days, but fever recurred in 15 patients (51.7%) at 10.9+/-3.4 days. Common laboratory features included lymphopenia (72.4%), thrombocytopenia (34.5%) and elevated C-reactive protein (CRP), lactate dehydrogenase (LDH), and aspartate aminotransferase (AST) (93.1, 62.1, 44.8%, respectively). All patients except one had initial abnormal chest radiographs and 20 (69.0%) had radiological worsening at 7.5+/-2.6 days. Nine patients (31.0%) subsequently required mechanical ventilation with four deaths (13.8%). Most patients with clinical deterioration responded to pulse corticosteroid therapy (14 out of 17) but six complicated with nosocomial infections. The risk factors associated with severe disease were presence of diarrhoea, high peak LDH and CRP, high AST and creatine kinase on admission and high peak values. CONCLUSIONS: Prudent corticosteroid use, vigilant microbiological surveillance and appropriate antibiotics coverage are the key to successful treatment.     

Noninvasive assessment of respiratory resistance in severe chronic respiratory patients with nasal CPAP.

Noninvasive measurement of respiratory resistance during nasal ventilatory support could be useful to assess the mechanical status of the patient and to optimize the ventilator settings. The aim was to investigate whether the forced oscillation technique (FOT) applied through a nasal mask allows reliable noninvasive estimation of respiratory resistance (Rrs) in patients with severe chronic respiratory disease. FOT Rrs (5 Hz) and lung resistance (R(L)) measured simultaneously from spontaneous breathing signals by an oesophageal balloon were compared in eight patients with chronic obstructive pulmonary disease and in six patients with a restrictive ventilatory defect due to chest wall disease. Measurements were performed in sitting and supine postures during application of nasal continuous positive airway pressure (CPAP): 4, 8 and 12 cmH2O in obstructive patients and 4 cmH2O in restrictive patients. In the restrictive patients Rrs and R(L) (in cmH2O x s x L(-1)) were virtually coincident: mean+/-SD, 12.6+/-6.1 and 11.6+/-6.6 (r=0.96) in sitting and 9.7+/-3.1 and 10.2+/-3.3 (r=0.92) in supine posture, respectively. In the obstructive patients (CPAP = 4 cmH2O), Rrs slightly underestimated R(L): mean+/-SD, 11.5+/-5.9 and 14.4+/-16.8 (r=0.92) in sitting and 15.0+/-9.8 and 21.1+/-12.6 (r=0.96) in supine posture, respectively. Similar results were found at CPAP = 8 and 12 cmH2O. The results obtained in patients with resistance values in the range typically found in nasal ventilatory support suggest that forced oscillation technique could be valuable to noninvasively estimate a patient's respiratory mechanical resistance.     

Improvement in exercise endurance in patients with chronic airflow limitation using continuous positive airway pressure

To cope with the increased ventilatory demands of exercise, patients with severe expiratory flow limitation adopt strategies that ultimately place greater demands on their inspiratory muscles. Increased inspiratory muscle work may contribute to dyspnea causation and exercise limitation in such patients even before their ventilatory ceiling is attained. In this setting, continuous positive airway pressure (CPAP) should, by favorably affecting inspiratory muscle function and respiratory sensation, improve exercise performance. Six patients with chronic airflow limitation (CAL) (FEV1 +/- SD = 35 +/- 12% predicted) undertook constant-load, submaximal, cycle exercise at 50% of their predetermined maximal oxygen consumption: CPAP of 4 to 5 cm H2O was delivered during one exercise session and bracketed by one or two unassisted control sessions. In four patients, CPAP-assisted (4 to 5 cm H2O) exercise was bracketed by two unassisted control exercise sessions; two remaining patients undertook CPAP-assisted exercise and one unassisted control session. CPAP resulted in a significant increase in exercise endurance time (TLIM) (by 48%: CPAP TLIM (mean +/- SE) = 8.82 +/- 1.90 min; averaged control TLIM = 5.98 +/- 1.23 min (p less than 0.01). CPAP effectively ameliorated exertional dyspnea in the majority of patients; selected dyspnea ratings (Borg scale) during control (final minute) and CPAP at isotime, at comparable levels of ventilation, were (mean +/- SD) 7.83 +/- 2.25 and 5.5 +/- 2.2, respectively (p less than 0.025). Breathing frequency fell significantly during CPAP application (at isotime) by 17% (p less than 0.02); other steady-state ventilatory variables and end-expiratory lung volumes were not significantly different during CPAP and control.(ABSTRACT TRUNCATED AT 250 WORDS)     

Mechanisms underlying effects of nocturnal ventilation on daytime blood gases in neuromuscular diseases.

The hypothesis that, in neuromuscular and chest wall diseases, improvement in central respiratory drive explains the effects of night-time ventilation on diurnal gas exchanges was tested. The effects at 6 months, 1, 2 and 3 yrs of intermittent positive pressure ventilation (IPPV) on arterial blood gas tension, pulmonary function, muscle strength, sleep parameters, respiratory parameters during sleep and ventilatory response to CO2 were evaluated in 16 consecutive patients with neuromuscular or chest wall disorders. As compared with baseline, after IPPV daytime arterial oxygen tension (Pa,O2) increased (+2.3 kPa at peak effect) and arterial carbon dioxide tension (Pa,CO2) and total bicarbonate decreased (-1.8 kPa and -5 mmol x L(-1), respectively) significantly; vital capacity, total lung capacity, maximal inspiratory and expiratory pressures and alveolar-arterial oxygen gradient did not change; the apnoea-hypo-opnoea index and the time spent with an arterial oxygen saturation (Sa,O2) value <90% decreased (-24 and -101 min, respectively), sleep efficiency and mean Sa,O2 increased (+16% and +5%, respectively); and ventilatory response to CO2 increased (+4.56 L x min(-1) x kPa(-1)) significantly. The reduction in Pa,CO2 observed after IPPV correlated solely with the increase in the slope of ventilatory response to the CO2 curve (r=-0.68, p=0.008). In neuromuscular or chest wall diseases, improvement of daytime hypoventilation with nocturnal intermittent positive pressure ventilation may represent an adaptation of the central chemoreceptors to the reduction of profound hypercapnia during sleep or reflect change in the quality of sleep.     

既往有心脑血管病对严重急性呼吸综合征患者病死率的影响

目的研究心脑血管基础疾病对严重急性呼吸综合征(SARS)患者病死率的影响。方法分析2003年北京市1291例SARS患者(其中121例死亡)的病例资料,比较既往有心脑血管基础疾病和有、无其他基础疾病三组SARS患者病死率的差异及死亡危险因素。结果SARS患者总的病死率为937%。既往有心脑血管疾病、其他基础病和无基础病的SARS患者病死率分别为2864%、1185%和449%(P<00001)。Logistic回归分析表明,调整年龄和职业后既往有心脑血管病的SARS患者死亡的相对危险是无基础病患者的183倍(P<005)。结论既往有心脑血管基础疾病是SARS患者死亡的重要危险因素之一。     

Surfactant and physiologic responses of preterm lambs to continuous positive airway pressure

Although continuous positive airway pressure (CPAP) is used frequently for preterm infants, the relationships between the amount of surfactant and lung physiologic and injury responses to CPAP are unknown. Therefore, saturated phosphatidylcholine (Sat PC) was measured to quantify the surfactant necessary for preterm lambs to breathe successfully on a CPAP of 5 cm H(2)O (CPAP 5). Five of 21 lambs delivered at 130-136 days gestation failed to keep PCO(2) below 100 mm Hg by 2 hours. The lambs that failed had less than 1.9 micromol/kg Sat PC in bronchoalveolar fluid (approximately 3% the pool size at term), less surfactant secretion, and less large aggregate surfactant. Physiologic responses of other 132-day preterm lambs after 2 or 6 hours of CPAP 5, 8 cm H(2)O CPAP (CPAP 8), or mechanical ventilation were then characterized. At 6 hours, oxygenation and lung gas volumes were higher with CPAP 8 relative to the other groups and VE was decreased with CPAP 8 relative to CPAP 5. Lung dry/wet ratios were greater for the CPAP groups than for the mechanical ventilation group. A small amount of endogenous Sat PC is required for preterm lambs to breathe successfully with CPAP. CPAP 8 improves early newborn respiratory transition relative to CPAP 5.     

Report of national survey on death due to tuberculosis in 1994 in national hospitals and the treatment and prognosis of tuberculous patients with mechanical ventilation

1. National survey on died patients with active tuberculosis (tbc) or tbc sequelae had been held in national hospitals every five year from 1959 (3433 cases) to 1994 (688 cases). In 1994, 330 patients died due to pulmonary tbc. Recent study revealed the decreased rate of death due to operation, or far advanced cavitary cases, and the increased rate of nontuberculous death, aged people (> 60 yrs), and nontuberculous complications. Main causes of death in pulmonary tbc were lung insufficiency (about half) and general weakness (almost one fifth) in any survey. Rapid progression of pulmonary tbc had been increased cause of death (20.9% in 1994). Main attributable factors of death in 1994 in pulmonary tbc cases were severe condition on admission (38.4%), disturbed lung function (31.2%) and old age (33.2%). Delayed treatment (13.9%) and complications (12.1%) were increasing factors. Early death within 3 months from onset in 1994 was seen in patients < 60 yrs as well as in patients > 80 yrs. Severity due to delayed treatment and rapid progression were supposed to the causes of early death. 2. During 1994 to 1997, mechanical ventilation (MV; > 24 hours) was applied to 18 patients with active pulmonary tuberculosis; 10 acute respiratory failure (ARF), 5 chronic respiratory failure (CRF), 2 central nervous system tbc and 1 hemoptysis. Only one ARF case and three CRF ones survived. ARF cases had low PaO2/FIO2 (about 100), low albuminemia, short MV period (7 cases: < 7 days) and steroid therapy (9 cases). CRF cases had higher PaO2/FIO2 (294), longer MV period (4 cases: > 30 days) and all CO2 narcosis. 3. Noninvasive positive pressure ventilation (NIPPV) was applied to 23 patients with pulmonary tbc sequelae. In 13 patients with stable chronic respiratory failure (mean PaO2 91 mmHg, PaCO2 82 mmHg) 10 continued NIPPV and started home mechanical ventilation (HMV). In 10 patients with acute on chronic respiratory failure (mean PaO2 61 mmHg, PaCO2 92 mmHg) 2 patients fell into tracheal intermittent positive pressure ventilation (TIPPV). Eight patients recovered with NIPPV and 5 started HMV. NIPPV is supposed to be very effective to treat severe chronic hypercapmic respiratory failure.