无创通气在呼吸衰竭患者治疗中的应用

目的 探讨无创通气治疗呼吸衰竭患者的疗效.方法 入选的90例患者均符合呼吸衰竭诊断标准,其中对照组45例,治疗组45例.对照组采用常规治疗方法,治疗组在常规治疗方法上加用无创通气.检测两组患者血PH值、动脉血氧分压(PaO2)、动脉二氧化碳分压( PaCO2)、心率、呼吸频率,统计住院时间、插管率及病死率.结果 治疗组在PH、PaO2、PaCO2、心率、呼吸频率的改善上均优于对照组(P＜0.05),治疗组住院天数少于对照组(P＜0.05),治疗组插管率明显低于对照组(P＜0.01),两组患者在死亡率上差异无统计学意义(P＞0.05).结论 无创通气具有无创、安全、治疗呼吸衰竭疗效确切等优点.     

Approach to respiratory failure in emergency department

OBJECTIVES AND BACKGROUND: The goal of this review is to provide update recommendations that can be used by emergency physicians who provide primary cares to patients with Acute Respiratory Failure (ARF), from the admission to an emergency department through the first 24 to 48 hours of hospitalization. This work wants to address the diagnosis and emergency medical care of ARF and the management of medical complications. STATE OF THE ART: A lot of statement has been developed for the early management and treatment of ARF; moreover, over the last fifteen years, we have assisted to the rise of a new technique of ventilation, in the Emergency Department: Non Invasive Ventilation. This kind of ventilation was firsthy applied in intensive Care and in Respiratory Care Unit. Randomized controlled clinical trials have showed its usefulness in the early treatment of several forms of ARF, together with medical therapy.     

Blood gas changes in acute respiratory failure

Summary

A study of the effect of an intravenously (aminophylline) and an intramuscularly (acepifylline) administered bronchodilator on arterial blood gases is described. The 24 patients studied were all severely ill and in severe respiratory failure, in contradistinction to patients in all other studies in this jield. The blood gas changes were followed over a period of 1 hour and no signijicant differences were found between the effects of the two drugs on arterial oxygen levels and arterial carbon dioxide.

Further analysis of the pooled results indicates that the increases in systemic oxygen level following parenterally adminstered bronchodilating agents is higher when the initial blood oxygen is low. This conclusion suggests that the theoretical extrapolation of other studies, which have suggested that a fall would be catastrophic if it was to occur in patients with a low initial blood oxygen level, may not be true. Instead, it would appear that in treating chronic bronchitic patients in respiratory failure with extremely low levels of arterial oxygen, bronchodilators do not cause severe falls in oxygen.     

鼻塞持续气道正压通气治疗新生儿呼吸衰竭临床观察

目的观察经鼻塞持续气道正压通气(N-CPAP)治疗新生儿呼吸衰竭的效果。方法应用STEPHANN-CPAP小儿呼吸机对30例危重新生儿进行经鼻塞持续气道正压通气呼吸支持治疗,观察治疗前后临床症状和血气变化。结果治疗有效25例,无效5例。治疗有效患儿使用N-CPAP时间12~96h,平均(32±4)h。并发症为鼻黏膜损伤,共12例。全部病例均治愈出院。结论N-CPAP治疗新生儿肺炎并呼吸衰竭及早产儿原发性呼吸暂停效果显著,是新生儿科一种简便易行、无创安全、疗效显著的呼吸支持设备。     

老年人重症呼吸衰竭的护理

目的：探讨老年人重症呼吸衰竭患者的护理干预手段,观察诊疗效果。方法60岁以上的重症呼吸衰竭患者86例的临床资料,分析采取的护理措施,得出最佳护理方案。结果78例患者病情缓解后出院,6例患者病情稳定,2例因肺癌晚期救治无效死亡,均无护理相关并发症发生。结论系统、科学、严谨的护理措施,可以帮助老年重症呼吸衰竭患者缓解病情,提高治愈率。