结核性呼吸衰竭的机械通气策略

目的 探讨肺结核呼吸衰竭的机械通气策略。方法 对52例肺结核呼吸衰竭行肺保护性通气策略的机械通气治疗，观察疗效及并发症。结果 呼吸衰竭治愈49例，死亡3例，治愈率94．2％，无明显并发症。结论 肺保护性机械通气对结核性呼衰治疗是安全的，且疗效显著。     

肺结核合并重症肺炎35例临床分析

目的　探讨肺结核合并重症肺炎的临床特征及病原菌分布和诊疗技术。方法 对1995年1月—2002年12月收治的经纤维支气管镜保护性刷检(PSB)病原学确诊的肺结核合并重症肺炎35例进行回顾性分析。结果 临床特征是高热、咳脓痰、气急、呼吸衰竭、白细胞总数升高。病原菌以嗜麦芽窄食单胞菌、厌氧菌、绿脓杆菌感染为主。治愈31例,病死4例,病死率11.4%。结论 纤支镜PSB检查能及时、准确提供肺结核合并重症肺炎的病原学诊断依据,并指导临床合理使用抗生素。第三代青霉素及头孢菌素与β内酰胺酶抑制剂的复合制剂及甲哨唑疗效显著。合理把握机械通气指征及策略,可提高救治成功率。     

低潮气量维持通气治疗老年肺结核合并呼吸衰竭的临床分析

目的　探索使用低潮气量维持通气对老年肺结核合并呼吸衰竭患者的血气分析影响。方法 在有效的抗结核、抗炎治疗的基础上，在各种通气参数保持不变的情况下，以使用呼吸机前，调节患者的潮气量分别为10mL/kg、8mL/kg、6mL/kg后1h及维持6mL/kg12h之血气分析进行比较。结果 以潮气量为6mL/kg维持通气治疗，PaCO₂及PaO₂/FiO₂较在使用呼吸机前有明显改善(P＜0.05)。结论 对于老年肺结核合并呼吸衰竭患者，使用低潮气量进行机械通气即可有效纠正呼吸衰竭。     

肺结核全肺切除术后严重并发症18例分析

目的　探讨肺结核全肺切除术后并发症发生原因及防治对策。方法 对我院69例肺结核全肺切除的术后发生严重并发症18例进行回顾分析。结果 69例病人中术后出现呼吸功能不全6例,支气管残端瘘3例,术后病灶向对侧播散2例,术后失血性休克(胸腔广泛渗血所致)5例,术后上消化道出血2例。术后急性呼吸衰竭死亡2例,胸腔内大面积渗血死亡2例。全组术后并发症发生率26.1%(18/69),治愈好转率94.2%(65/69),死亡比例5.8%(4/69)。结论 全肺切除仍是治疗某些肺结核的有效手段之一,但应掌握好手术适应证和手术时机。结果表明:肺结核化疗效果不满意(包括耐药因素)、术中操作失误及术后管理不当仍是肺结核的外科治疗,特别是全肺切除术后产生并发症的主要原因。     

肺结核并发肺曲菌球47例外科治疗

目的　探讨肺曲菌球与肺结核的关系及其诊断和治疗;方法 对13年经外科手术治疗的47例肺结核合并曲菌球病人进行回顾性分析;结果 男性31例,占66.0%,病程>5年27例。咯血症状突出,41例,占87.2%。47例肺结核合并曲菌球中,术前明确诊断32例,占68.1%,漏误诊率31.8%。45例治愈,占95.7%,死亡2例,占4.2%。术后并发症10例,分别为胸腔感染、支气管胸膜瘘、肺炎、肺不张、支气管哮喘、呼吸衰竭和失血性休克。结论 肺曲菌球病见于肺结核空洞患者,在长期规律抗结核治疗后仍反复咯血,漏诊率较高,手术治疗为首选,效果较好。     

双水平正压通气呼吸机治疗肺结核并呼吸衰竭的疗效观察

目的观察双水平正压通气呼吸机(BiPAP呼吸机)治疗肺结核合并呼吸衰竭的疗效。方法31例肺结核合并慢性呼吸衰竭为治疗组,20例为对照组。结果2组治疗后动脉血氧分压(P_aO₂)、血氧饱和度(Sa_aO₂)明显上升,治疗组血二氧化碳分压(P_aCO₂)比治疗前明显下降(P<0.01),呼吸困难明显减轻。结论用BiPAP呼吸机辅助通气治疗肺结核合并呼吸衰竭的疗效较好,可提高P_aO₂、降低P_aCO₂,预防肺性脑病的发生。     

结核性呼吸衰竭的机械通气及纤支镜介入治疗

目的 探讨机械通气及纤维支气管镜介入对肺结核呼吸衰竭的治疗方法及疗效。方法 对39例肺结核呼吸衰竭患行IPPV/assit模式机械通气及纤支镜吸痰和药物灌注治疗,观察病情变化及血气、胸片等疗效指标。结果 呼吸衰竭治愈37例,死亡2例,治愈率94.9%。结论 结核性呼吸衰竭采用低吸气压及低潮气量的肺保护性机械通气是切实可行的,IPPV／assist模式机械通气及纤支镜介入对结核性呼吸衰竭疗效显。     

长期排菌肺结核的外科治疗

目的　探讨肺结核化疗时代胸外科手术治疗长期排菌病例的重要性,手术适应征及手术时机的选择。方法 对内科治疗一年以上仍排菌的63例肺结核空洞或结核性毁损肺采用不同术式切除不可逆病灶或附加胸廓成型术。结果 59例痰菌阴转,阴转率达93.7%,4例术后出现并发症,无手术死亡。结论 肺外科手术是治疗长期排菌合并空洞及毁损肺患者有效的方法。术后应继续抗结核治疗至少一年。     

耐药性肺结核的手术治疗(附36例报告)

目的　探讨耐药肺结核的手术适应症及手术时机。方法 对1990～1997年我院收治的7000肺结核和36例耐药肺结核已手术治疗的病人的手术效果进行回顾分析。结果 36例肺结核病人,临床治愈率94%,痰菌阴转率84%,并发症发生率为13%。结论 对部分耐2～3种药的肺结核病人选择外科治疗仍是可行的,可提高耐药肺结核的治愈率,耐4种以上的肺结核病人术后并发症发生率高,应慎重选择。     

肺结核不同病情对呼吸阻抗的影响

目的　探讨肺结核不同病情对呼吸阻抗的影响,评价脉冲振荡法(IOS)测定肺结核患者呼吸阻抗的临床意义。方法 观察比较肺结核轻度组60例、中度组48例、重度组40例和健康组30例的IOS各指标,148例肺结核患者IOS各指标与肺通气功能指标实测值作相关分析。结果 肺结核各组随病情加重,共振频率(Fres),呼吸总阻抗(Zrs),总气道阻力(R₅),中心气道阻力(R₂₀),周边气道阻力(R₅-R₂₀)和周边弹性阻力(X₅的负值)逐渐增大,但与健康组比较,肺结核轻度组各项指标无差异(P>0.05),肺结核中度组除R₂₀外其余各项均有显著性差异(P<0.05),肺结核重度组各项均有显著性差异(P<0.01)。148例肺结核患者IOS各指标与肺通气功能指标相关分析显示:Fres、Zrs、R₅、R₂₀和R₅-R₂₀分别与肺通气功能各指标呈显著负相关(P<0.001),X5与肺通气功能各指标呈显著正相关(P<0.001);Fres与MVV相关性最强。结论 肺结核不同病情对呼吸阻抗影响差异很大。IOS法测定呼吸阻抗在肺结核临床应用中前景宽广。     

机械通气患者并发症分析与防治策略

机械通气过程中可产生诸多并发症，本报道机械通气抢救呼吸衰竭患110例，发生并发症75例，发生率为68.18%，其中以循环系统和消化系统并发症为最多，1例死于并发症消化道出血。本对并发症的原因进行分析，并提出防治措施。     

机械通气治疗急性重度有机磷农药中毒并呼吸衰竭的临床研究

目的 探讨机械通气在急性重度有机磷农药中毒( ASOPP)并呼吸衰竭患者救治中的临床价值.方法 分析2003年5月至2010年12月收治的ASOPP合并呼吸衰竭患者92例,其中机械通气治疗组(A组)47例,未行机械通气治疗组(B组)45例,比较两组住院时间及临床疗效.结果 A组住院时间明显短于B组(P＜0.01),而临床疗效显著高于B组(P＜0.01).结论 机械通气是救治ASOPP并呼吸衰竭的重要方法,能显著提高临床治愈率,缩短住院时间.     

25例结核性支气管狭窄死亡病例分析

目的分析结核性支气管狭窄病例死亡原因,探讨治疗措施的相关问题。方法回顾分析我院2008年6月至2009年12月收治的结核性支气管狭窄死亡病例25例及临床资料。结果 25例患者均因弥漫性气管、支气管狭窄致急性呼吸窘迫综合征死亡;其中12例行人工气道机械通气等治疗,13例行面罩式无创机械通气等治疗。结论 25例气管狭窄死亡病例,死亡原因均为弥漫性气管、支气管狭窄致急性呼吸窘迫综合征死亡,行机械通气等抢救措施治疗均无效,因此寻求新的抢救措施势在必行。     

经鼻气管插管机械通气抢救呼吸衰竭97例临床分析

目的探讨经鼻气管插管机械通气治疗呼吸衰竭的应用价值。方法对97例慢性呼衰急性加重或急性呼衰患者行纤维支气管镜引导下经鼻气管插管机械通气治疗。结果88例抢救成功，顺利脱机拔管，死亡9例。抢救成功率90．7％。结论通过该法建立人工气道并机械通气抢救呼吸衰竭疗效满意。     

Complications of mechanical ventilation. A clinical analysis of 82 cases]

The complications of mechanical ventilation were analysed retrogradely in 82 cases with respiratory failure treated in ICU in recent 5 years. There were 48 males and 34 females ranging from 28 to 82 years of age (mean age: 57.1 +/- 16.8). In 82 cases, 6 cases had complications of barotrauma, 39 cases, of infections, 15 cases, of hypotension, 24 cases, of arrhythmia, 14 cases, of upper gastrointestinal hemorrhage and 10 cases, of multiple organ failure. The total incidence of complication was 76.8%. Exactly within three days of mechanical ventilation, the incidence of complication was 31.3%, while beyond three days, it was 87.9%. It was indicated that the mortality increased significantly in the cases with severe complications such as, multiple organ failure. The causes of all kinds of complications and their prevention as well as treatments were discussed.     

Two Cases of Severe COVID-19 Pneumonia Effectively Treated with Extracorporeal Membrane Oxygenation in Addition to Favipiravir and Corticosteroid

Case 1: A 65-year-old man with novel coronavirus infection (COVID-19) complicated with acute respiratory failure. On admission, the patient was started on favipiravir and corticosteroid. However, due to a lack of significant improvement, he was introduced to mechanical ventilation and extracorporeal membrane oxygenation (ECMO). Although iliopsoas hematoma occurred as a complication, the patient recovered. Case 2: A 49-year-old man with COVID-19 had been started on favipiravir and corticosteroid. Due to progressive respiratory failure, the patient underwent mechanical ventilation and ECMO. The patient recovered without complications. We successfully treated these severe cases with a multimodal combination of pharmacological and non-pharmacological supportive therapy.     

Chronic graft-versus-host disease-related polymyositis as a cause of respiratory failure following allogeneic bone marrow transplant

An unusual case of respiratory failure and dropped head syndrome as a complication of severe chronic graft-versus-host disease (GVHD)-related polymyositis is described. The patient required tracheostomy and mechanical ventilation but recovered following treatment with aggressive immunosuppression and intensive rehabilitation. The differential diagnoses of muscle weakness in the bone marrow transplant (BMT) patient and the dropped head syndrome are both discussed. To our knowledge, this is the first reported case of respiratory failure requiring mechanical ventilation occurring as a complication of GVHD-related polymyositis.     

对慢性阻塞性肺疾病呼吸衰竭机械通气治疗的再认识

目的探讨对慢性阻塞性肺疾病（COPD）呼吸衰竭机械通气的策略。方法回顾性总结82例需机械通气的COPD患者的治疗情况。结果75例患者脱机成功（91．5％）死亡7例（8．5％）。相关并发症：呼吸机相关肺炎8例,气管导管阻塞6例,单肺通气3例,低血压2例,气胸1例。结论及早行机械通气是治疗呼吸衰竭最有效和迅速的方法,加强气道管理、合适的通气策略、营养支持、控制感染是减少并发症和提高抢救成功的关键。     

The effect of non-invasive mechanical ventilation in postoperative respiratory failure

Postoperative respiratory failure is related with the highest mortality and morbidity among all perioperative complications. The most common underlying mechanism of postoperative respiratory failure is the development of atelectasis. Anaesthesia, medications which cause respiratory depression, high FiO2 use, postoperative pain and disruption of muscle forces due to surgery leads to decrease in functional residual capacity and results in atelectasis formation. Atelectasis causes severe hypoxemia due to ventilation, perfusion mismatch, shunt and increased peripheral vascular resistance. Intrathoracic positive pressure is an effective therapeutic option in both prevention and treatment of atelectasis. Non-invasive mechanical ventilation is related with a lower mortality and morbidity rate due to lack of any potential complication risks of endotracheal intubation. Non-invasive mechanical ventilation can be applied as prophylactic or curative. Both of these techniques are related with lower reintubation rates, nosocomial infections, duration of hospitalization and mortality in patients with postoperative respiratory failure. The differences of this therapy from standard application and potential complications should be well known in order to improve prognosis in these group of patients. The primary aim of this review is to underline the pathogenesis of postoperative respiratory failure. The secondary aim is to clarify the optimum method, effect and complications of non-invasive mechanical ventilation therapy under the light of the studies which was performed in specific patient groups.