Update on the management of COPD

COPD is highly prevalent and will continue to be an increasing cause of morbidity and mortality worldwide. COPD is now viewed under a new paradigm as preventable and treatable. In addition, it has become accepted that COPD is not solely a pulmonary disease but also one with important measurable systemic consequences. Patients with COPD have to be comprehensively evaluated to determine the extent of disease so that therapy can be adequately individualized. We now know that smoking cessation, oxygen for hypoxemic patients, lung reduction surgery for selected patients with emphysema, and noninvasive ventilation during severe exacerbations have an impact on mortality. The completion of well-planned pharmacologic trials have shown the importance of decreasing resting and dynamic hyperinflation on patient-centered outcomes and the possible impact on mortality and rate of decline of lung function. In addition, therapy with pulmonary rehabilitation and lung transplantation improve patient-centered outcomes such as health-related quality of life, dyspnea, and exercise capacity. Rational use of single or multiple therapeutic modalities in combination have an impact on exacerbations and hospitalizations. This monograph presents an integrated approach to patients with COPD and updates their management incorporating the recent advances in the field. The future for patients with COPD is bright as primary and secondary prevention of smoking becomes more effective and air quality improves. In addition, current research will unravel the pathogenesis, clinical, and phenotypic manifestations of COPD, thus providing exciting therapeutic targets. Ultimately, the advent of newer and more effective therapies will lead to a decline in the contribution of this disease to poor world health.     

无创正压通气治疗慢性阻塞性肺疾病致肺性脑病的临床观察

目的:评价应用无创正压通气治疗慢性阻塞性肺疾病导致肺性脑病的临床效果。方法:采用回顾性研究方法,观察68例COPD导致呼吸衰竭患者使用双水平无创呼吸机辅助通气,动态观察比较治疗前和治疗后动脉血气及相关临床指标。结果:68例患者中有50例治疗好转后出院,8例需要行气管插管机械通气,10例放弃治疗,有效率为73.53%。结论:无创正压通气对部分慢性阻塞性肺疾病致肺性脑病的治疗有效,临床可酌情扩大无创正压通气的适应证,合理使用可避免早期气管插管机械通气治疗。     

非侵入性呼吸支持治疗新生儿呼吸窘迫综合征临床观察

目的观察非侵入性呼吸支持对新生儿呼吸窘迫综合征的临床疗效。方法将胎龄≤35周,且符合新生儿呼吸窘迫综合征（NRDS）诊断标准的82例早产儿作为观察对象。尽早给予NCPAP支持,若失败则改用NIPPV支持,必要时使用Ps或机械通气。结果82例观察对象全部使用了NCPAP,其中19例因效果不明显改用了NIPPV,66例使用了Ps;72h内无一例使用有创机械通气,但有4例患儿后期因合并院内感染或BPD使用了气管插管机械通气;82例中1例因先天性肠闭锁于生后第二天转外科手术治疗,1例因经济原因于第2天签字出院,其余80例均痊愈出院。结论无创呼吸支持用于治疗早产儿NRDS疗效肯定,部分患儿如果尽早使用NCPAP或NIPPV,可以不使用PS。因无创呼吸支持经济便捷,值得临床推广应用。     

Nasal intermittent positive pressure ventilation with or without very early surfactant therapy for the primary treatment of respiratory distress syndrome

Aim: Current evidence suggests that nasal intermittent positive pressure ventilation (NIPPV) as a primary treatment for RDS reduces the duration of invasive mechanical ventilation (MV) comparing with nasal continuous airway pressure (NCPAP). We aimed to evaluate whether very early surfactant treatment decreases the need for MV when used in premature infants treated with early NIPPV soon after birth.

Methods: The inclusion criteria of this prospective cohort study were a gestational age of 24–31^6/7 weeks and supplemental oxygen with the evidence of labored breathing within 60?min. Infants were stabilized on NCPAP and then continued with NIPPV, following early surfactant treatment, or were only put on NIPPV. Thirty infants in the NIPPV group and 29 infants in the NIPPV?+?SURFACTANT group met the inclusion criteria. Primary end-point was the need of MV in the first 72?h of life according to the predefined criteria.

Results: The failure rate was significantly lower in the NIPPV?+?SURFACTANT group compared with the NIPPV group (37.9% and 66.7% respectively, p?<?0.05). All other results, including bronchopulmonary dysplasia and death, were similar between the groups.

Conclusion: NIPPV failure was significantly lower when combined with surfactant treatment, which indicates the critical role of early surfactant treatment in reducing the need for invasive ventilation.     

专职护理小组在呼吸衰竭患者接受无创正压通气治疗的作用

目的探讨专职护理小组对呼吸衰竭患者接受无创正压通气（NPPV）治疗的作用。方法选择在普通病房实施NPPV治疗的患者,对照组进行常规护理,干预组由无创通气护理小组进行干预护理。结果两组NPPV治疗前,治疗后2小时动脉血气分析结果,干预组优于对照组,干预组在成功率、依从性明显高于对照组,差异有统计学意义（P〈0．05）。结论专职护理小组可提高呼吸衰竭接受NPPV治疗患者的护理质量,提高患者的舒适度。     

Noninvasive Positive Pressure Ventilation

Abstract

The National Association of EMS Physicians (NAEMSP) believes that noninvasive positive pressure ventilation (NIPPV) is an important treatment modality for the prehospital management of acute dyspnea. This document is the official position of the NAEMSP.     

乌司他丁联合无创正压通气治疗48例急性肺损伤患者血气指标分析及临床疗效比较

目的研究乌司他丁联合无创正压通气(NIPPV)治疗急性肺损伤(ALI)患者血气指标及临床疗效。方法选择ALI患者作为研究对象,随机分为观察组(给予乌司他丁联合NIPPV治疗)和对照组(乌司他丁联合气管插管、呼吸机辅助呼吸治疗),观察两组血气和药代动力学指标。结果观察组动脉血氧分压(PaO2)、氧和指数(PaO2/FiO2)、pH值、乌司他丁浓度峰值均明显高于对照组,动脉血二氧化碳分压(PaCO2)达到峰值的时间和半衰期明显低于对照组。结论乌司他丁联合NIPPV治疗ALI患者能够有效的改善血气指标、保证血药浓度,具有积极的临床价值。     

Myasthenic crisis patients who require intensive care unit management

The purpose of this report was to investigate predictive factors that necessitate intensive care in myasthenic crisis (MC). We retrospectively reviewed MC patients at our institution and compared ICU and ward management groups. Higher MG-ADL scale scores, non-ocular initial symptoms, infection-triggered findings, and higher MGFA classification were observed more frequently in the ICU group. In patients with these prognostic factors, better outcomes may be obtained with early institution of intensive care. Muscle Nerve 46: 440-442, 2012.     

无创正压通气用于急性心肌梗死合并肺水肿的临床疗效观察

目的分析无创正压通气用于治疗心肌梗死合并肺水肿的临床疗效。方法选取70例急性心肌梗死合并肺水肿的患者,随机分成两组,对照组35例使用普通面罩吸氧等常规治疗;观察组35例在常规治疗基础上进行双向正压通气治疗。观察患者的心率、血压、呼吸频率、血清BNP以及动脉血气指标的变化。结果观察组进行正压通气治疗2h和24h后呼吸频率、PaO2改善情况均好于对照组,差异具有统计学意义（P〈0．05）;治疗72h后,治疗组的血清BNP水平明显低于对照组（P〈0．01）。结论无创正压通气能够有效改善急性心肌梗死患者的肺水肿,具有较好的疗效,适合推广应用。     

急性左心衰合并呼吸衰竭拔管后NIPPV序贯治疗时机的研究

目的：探讨急性左心衰竭合并呼吸衰竭患者拔管后采用无创正压通气（ NIPPV）序贯治疗的时机。方法抽选我院60例先行气管插管有创通气治疗的急性左心衰竭合并呼吸衰竭患者,待病情有所控制后,分别以患者自主呼吸试验时间（30 min、2 h和24 h）为气管拔管时机,开始NIPPV序贯治疗,比较各时间点NIPPV序贯治疗后的脱机成功率。结果3组气管插管前MAP、RR、HR、pH以及PaO2、PaCO2指标比较差异无显著性（ P﹥0.05）。30 min组、2 h组和24 h组脱机成功率分别为10％、80％、85％,2 h组和24 h组脱机成功率与30 min组比较差异显著（ P﹤0.05）,2 h组和24 h组两组之间比较差异无显著性（ P﹥0.05）。结论急性左心衰合并呼吸衰竭患者当自主呼吸试验时间﹥2 h时,即可拔管予以NIPPV序贯治疗,脱机成功率高,并且不增加48 h再插管率,值得临床推广选择。