氦氧混合气体治疗慢阻肺急性加重期的临床评价

目的评价氦氧混合气体(Heliox)治疗慢性阻塞性肺病急性加重期(AECOPD)患者的临床疗效。方法回顾分析2004-08～09急诊ICU收治的54例AECOPD患者的临床资料,按是否接受Heliox治疗将患者分为常规治疗组(28例)和Heliox治疗组(26例),前者给予常规治疗,后者在常规治疗基础上予吸入Heliox治疗,比较两组患者有创机械通气使用率、平均机械通气时间、平均ICU治疗时间、平均住院时间和预后等参数。结果Heliox治疗组患者有创机械通气使用率显著低于常规治疗组,而且平均有创机械通气时间、平均ICU治疗时间和平均住院时间均显著短于常规治疗组,但两组患者病死率比较差异无统计学意义。结论AECOPD患者吸入Heliox治疗具有较好的临床疗效。     

氦氧混合气体治疗呼吸衰竭的机制及临床应用

机械通气作为治疗呼吸衰竭的最后有效手段 ,却因多采用正压通气方式 ,很难避免容积、气压伤。氦气 (Ｈｅｌｉｕｍ ,Ｈｅ)是一种小分子惰性气体 ,其与氧混合形成的氦 -氧混合气 (Ｈｅｌｉｏｘ)具有降低气道压、促进氧气向肺泡弥散及二氧化碳排除的优点 ,可减少机械通气并发症[1] 。近年有关Ｈｅｌｉｏｘ治疗呼吸衰竭的研究与应用在国外发展迅速 ,而国内鲜有报道[2 ,3 ] 。本研究的目的在于进一步探讨Ｈｅｌｉｏｘ治疗呼吸衰竭的机制 ,以期在临床上推广这一非药物疗法。1　材料与方法1.1　基础部分健康杂种犬 6只 ,按交叉设计方法及自身对照方…     

氦氧混合气体在治疗气流阻塞性肺疾病中的应用

气流阻塞性肺疾病主要包括COPD和支气管哮喘,两者的共同特征为呼出气流受限.由于气道阻力增高,导致肺动力性过度充气,内源性呼气末正压的存在,使呼吸功明显增加.而氦气是一种低密度气体,可以降低气道阻力、减少残气量,从而减轻内源性呼气末正压,减少呼吸功,改善肺功能.     

慢性阻塞性肺疾病患者急性加重期行氦-氧机械通气的护理体会

目的：探讨慢性阻塞性肺疾病急性加重期( acute exacerbation of chronic obstructive pulmonary dis-ease,AECOPD)行氦-氧机械通气的护理要点,并进行临床观察。方法对2013年6月至2015年12月本院重症医学科收治的60例AECOPD行氦-氧机械通气的患者进行回顾性分析。所有患者均在传统治疗基础之上接受氦-氧机械通气治疗,并进行针对性护理。治疗结束后,观察患者临床疗效及护理过程中的不良反应,并对护理要点进行总结与分析。结果接受氦-氧机械通气治疗后,患者氧分压( PaO2)升高,二氧化碳分压( PaCO2)降低,气道峰值压力Ppeak降低,SpO2与pH均升高,与治疗前相比,差异均有统计学意义( P<0.05)。治疗显效34例,有效21例,无效5例,治疗总有效率为91.67%。治疗期间,无明显不良反应发生。结论对经氦-氧机械通气治疗的AECOPD患者进行有效治疗的护理措施,能够减轻疾病导致的呼吸不畅,降低气道压力,改善血气指标,减少CO2潴留,提升患者生活质量,值得临床推广。     

对氦氧混合气体治疗和检测呼吸道疾病缺氧的再评价

目的 :探讨氦氧混合气体在呼吸道疾病缺氧的康复治疗和检测方面的作用。方法 :2组非吸烟健康志愿成人分别呼吸含 80 %氦和 60 %氦的氦氧混合气体 ,并测定比较其前后肺活量及其组成的变化。结果 :2组受检者基础肺功能测定结果差异无显著 (P >0 .0 5) ,且呼吸氦氧混合气体后肺活量及其组成的测定结果及变化率两相比较差异也无显著 (P >0 .0 5) ,但其波动性较大 ,平行性较差。结论 :氦氧混合气体在治疗呼吸道疾病缺氧症状时 ,氦浓度不低于 60 %仍可获得与含 80 %氦的氦氧混合气体一样的临床效果 ;但在阻塞性呼吸道疾病的检测方面 ,因其影响因素较多 ,波动性大而欠缺理想的平行性 ,重复性较差 ,不是一种理想的和值得推荐的实验材料     

负离子氧疗法治疗慢性阻塞性肺病的疗效观察

目的结合空气负离子与氧疗法医学理疗原理,调研负离子氧疗法对慢性阻塞性疾病的辅助治疗效果。方法临床调查60例患者案例,收集并阅读资料。结果空气负离子与氧气疗法都有治疗慢性阻塞性肺病的功效,两者结合更能相辅相成,提高患者SaO2,提高生活质量,减少失眠、厌食、感冒等现象。结论空气负离子疗法与氧疗法都是新兴的疗养法,在医学上的应用范围很广,而将两者完美结合,更是一种全新的理疗模式。我们应积极探讨并合理利用两者的优势资源,将空气负离子疗法与氧疗法相互交融在一起,不断提高疗养质量。     

慢性阻塞性肺病的非药物治疗

叙述戒烟和减少慢性阻塞性肺病 (chronicobstructivepulmonarydisease ,COPD)所致残疾的方法及其作用。随着COPD患者支持组织对患者享受更好服务的支持不断增强 ,COPD患者的政治处境也不断改善     

慢性阻塞性肺病治疗的策略和措施

慢性阻塞性肺病(chronic obstructive pul-monary diseases,COPD)的发病率和死亡率已成为一个重要的全球性健康问题,目前是第4位死因,估计在2020年将成为第3位死因。因此,极应重视COPD的治疗,尤其是明确治疗的目标和策略,并据此采取相应的治疗措施,以达到事半功倍的效果。COPD的治疗包括稳定期(缓解期)和急性加重期治疗两大部分。作者根据GOLD诊治指南和中国的经验,将COPD治疗的策略和措施总结如下,供临床参考。     

Helium-oxygen reduces work of breathing in mechanically ventilated patients with chronic obstructive pulmonary disease

Objective To evaluate whether helium-oxygen mixture reduces inspiratory work of breathing (WOB) in sedated, paralyzed, and mechanically ventilated patients with acute exacerbation of chronic obstructive pulmonary disease (COPD).Design and setting Open, prospective, randomized, crossover study in the medical intensive care unit in a university hospital.Patients and participants 23 patients admitted for acute exacerbation of COPD and mechanically ventilated.Measurements Total WOB (WOBt), elastic WOB (WOBel), resistive WOB (WOBres), and WOB due to PEEPi (WOBPeepi) were measured. Static intrinsic positive end expiratory pressure (PEEPi), static compliance (Crs), inspiratory resistance (Rins), inspiratory (tinsp) and expiratory time constant (texp) were also measured. These variables were compared between air-oxygen and helium-oxygen mixtures.Results WOBt significantly decreased with helium-oxygen (2.34±1.04 to 1.85±1.01 J/l, p<0.001). This reduction was significant for WOBel (1.02±0.61 J/l to 0.87±0.47, p<0.01), WOBPeepi (0.77±0.38 J/l to 0.54±0.38, p<0.001), and WOBres (0.55±0.19 J/l to 0.44±0.24, p<0.05). PEEPi, Rins, tinsp and texp significantly decreased. Crs was unchanged.Conclusions Helium-oxygen mixture decreases WOB in mechanically ventilated COPD patients. Helium-oxygen mixture could be useful to reduce the burden of ventilation.     

Predictors of extubation failure in patients with chronic obstructive pulmonary disease

Few studies have focused on extubation outcome in patients with chronic obstructive pulmonary disease (COPD) requiring mechanical ventilation (MV). We conducted a study using prospectively collected data in a cohort of patients with COPD requiring invasive MV to identify variables associated with extubation failure. Use of noninvasive or invasive MV within 48 hours after extubation was defined as extubation failure. A total of 148 patients with COPD were studied. Extubation failure occurred in 35% of studied patients. Using multiple regression analysis, independent predictors of extubation failure were physiologic abnormalities measured by Simplified Acute Physiology Score II above 35 on intensive care unit (ICU) admission (odds ratio [OR], 3.88; 95% confidence interval [CI], 1.65-9.12), home noninvasive MV (OR, 12.99; 95% CI, 2.86-58.89), and sterile endotracheal aspirations on the day of extubation were predictors of success (OR, 0.23; 95% CI, 0.10-0.52). Despite high rate of extubation failure, survival to ICU discharge was 91% of the studied population. Extubation failure in patients with COPD remains high despite a successful spontaneous breathing on T piece. Simplified Acute Physiology Score II at ICU admission, home noninvasive MV, and isolated pathogens on quantitative cultures of tracheobronchial secretions within 72 hours preceding extubation were predictors of extubation failure in the study population.     

Comparative effects of helium-oxygen and external positive end-expiratory pressure on respiratory mechanics,gas exchange,and ventilation-perfusion relationships in mechanically ventilated patients with chronic obstructive pulmonary disease

Objective To compare the effects of He/O₂ and external PEEP (PEEPe) on intrinsic PEEP (PEEPi), respiratory mechanics, gas exchange, and ventilation/perfusion (_A/) in mechanically ventilated COPD patients.Design and setting Prospective, interventional study in the intensive care unit of a university hospital.Interventions Ten intubated, sedated, paralyzed, mechanically ventilated COPD patients studied in the following conditions: (a) baseline settings made by clinician in charge, air/O₂, ZEEP; (b) He/O₂, ZEEP; (c) air/O₂, ZEEP; (d) air/O₂, PEEPe 80% of PEEPi. Measurements at each condition included _A/ by the multiple inert gas elimination technique (MIGET).Results PEEPi and trapped gas volume were comparably reduced by He/O₂ (4.2±4 vs. 7.7±4 cmH₂O and 98±82 vs. 217±124 ml, respectively) and PEEPe (4.4±1.3 vs. 7.8±3.6 cmH₂O and 120±107 vs. 216±115 ml, respectively). He/O₂ reduced inspiratory and expiratory respiratory system resistance (15.5±4.4 vs. 20.7±6.9 and 19±9 vs. 28.8±15 cmH₂O l^–1s^–1, respectively) and plateau pressure (13±4 vs. 17±6 cmH₂O). PEEPe increased airway pressures, including total PEEP, and elastance. PaO₂/FIO₂ was slightly reduced by He/O₂ (225±83 vs. 245±82) without significant _A/ change.Conclusions He/O₂ and PEEPe comparably reduced PEEPi and trapped gas volume. However, He/O₂ decreased airway resistance and intrathoracic pressures, at a small cost in arterial oxygenation. He/O₂ could offer an attractive option in COPD patients with PEEPi/dynamic hyperinflation.     

慢性阻塞性肺疾病合并呼吸衰竭的肺保护性通气研究

目的 研究慢性阻塞性肺疾病(chronic obstructive pulmonary disease COPD)合并呼吸衰竭患者进行小潮气量机械通气的肺保护效果。方法 35例COPD合并呼吸衰竭患者分为小潮气量组(17例)和常规潮气量通气组(18例)，观察两组患者机械通气后支气管肺泡灌洗液(BALF)中肿瘤坏死因子α(TNF—α)、白细胞介素-6(IL-6)、白细胞介素-8(IL-8)的变化，机械通气期间发生呼吸机相关性肺损伤的情况，机械通气时间、平均住院时间及最终预后情况。结果 两组患者在存活率方面差异无显著性意义；小潮气量组机械通气后BALF中TNF—α、IL-6、IL-8的水平明显低于常规通气组；小潮气量组气压伤发生率、机械通气时间、住院时间也明显少于常规通气组。结论 对于COPD合并呼吸衰竭患者，选用小潮气量进行机械通气，可以减轻机械牵拉诱发的细胞因子释放，减轻机械通气相关性肺损伤，缩短机械通气时间和住院时间。     

Short-term effects of prone position in chronic obstructive pulmonary disease patients with severe acute hypoxemic and hypercapnic respiratory failure

Objective To assess the short-term effects of prone positioning (PP) in chronic obstructive pulmonary disease (COPD) patients with severe hypoxemic and hypercapnic respiratory failure requiring invasive mechanical ventilation.Design and setting Prospective observational study in the general intensive care unit of a university-affiliated hospital.Patients 11 consecutive COPD patients with persistent hypoxemia (PaO₂/FIO₂ 200 mmHg with FIO₂ 0.6) and hypercapnia requiring invasive mechanical ventilation. Patients with adult respiratory distress syndrome or left ventricular failure were excluded. Mean age was 73±11 years, mean weight 86±31 kg, mean SAPS II 53±10, and ICU mortality 36%.Interventions Patients were turned every 6 h.Measurements and results A response to PP (20% or greater PaO₂/FIO₂ increase) was noted in 9 (83%) patients. Blood gases were measured in the PP and supine (SP) positions 3 h after each turn, for 36 h, yielding six measurement sets (SP1, PP1, SP2, PP2, SP3, and PP3). PaO₂/FIO₂ was significantly better in PP: 190±26 vs. 113±9 mmHg for PP1/SP1, 175±22 vs. 135±16 mmHg for PP2/SP2, and 199±24 vs. 151±13 mmHg for PP3/SP3. After PP1 PaO₂/FIO₂ remained significantly improved, and the PaO₂/FIO₂ improvement from SP1 to SP2 was linearly related to PaO₂/FIO₂ during PP1 (r=0.8). The tracheal aspirate volume improved significantly from SP1 to PP1. PaCO₂ was not significantly affected by position.Conclusions PP was effective in treating severe hypoxemia in COPD patients. The first turn in PP was associated with increased tracheal aspirate.This article refers to the editorial     

慢性阻塞性肺疾病患者机械通气时间的影响因素

目的 探讨影响慢性阻塞性肺疾病(COPD)患者机械通气(MV)时间的危险因素.方法 回顾性研究128例COPD合并呼吸衰竭患者插管前及通气过程中的临床指标.单凶素分析采用t检验、秩和检验及X2检验.将统计意义的变量导人多元逐步togis～e回归分析.结果 NV>7 d、14 d和21 d的患者比例分别为61%、20%和9%.MV>7 d、14 d和21 d的患者,分别与MV≤7 d、14 d和21 d的患者进行比较,在COPD病史、吸烟指数、肺功能和合并症等方面差异无统计学意义(P<0.05).多因素回归分析显示,APACHEⅡ评分是影响MV>7 d的独立危险因子(OR:2.3;95%CI:1.2～5.7,P=0.02);影响MV>21 d的危险因素是休克(OR:0.7;95%CI:1.0～1.9,P=0.04)和低白蛋白水平(OR:0.4,95%CI:0.2～0.8,P=0.003);机械通气相关性肺炎(VAP)是影响机械通气时间最重要的危险因素(P<0.05).结论 APACHEⅡ评分、血清白蛋白水平、发生休克或VAP是影响COPD患者机械通气时间的主要因素.     

呼吸训练对COPD患者脱机后肺功能及抑郁情绪的影响

目的：观察呼吸训练对慢性阻塞性肺疾病（COPD）患者脱机后肺功能及抑郁情绪的影响。方法：将60例采用机械通气治疗的COPD患者脱机后随机分为训练组（30例）及对照组（30例）。对照组患者仅给予常规治疗，训练组患者在此治疗基础上加用呼吸训练，治疗时间持续9．12个月。2组患者均于脱机后l周内及治疗9～12个月期间对其进行肺功能和抑郁自评量表（SDS）评定。结果：训练组患者经9～12个月治疗后，与治疗前及对照组治疗后相应数据比较，其肺功能各项指标均改善显著（P〈0．05），SDS评分亦显著低于训练前及对照组治疗后相应数据（P〈0．05）。结论：对于脱机后的COPD患者应尽早给予呼吸功能训练，可显著改善患者的肺功能及抑郁情绪，值得临床进一步推广、应用。     

有创与无创序贯性机械通气治疗慢性阻塞性肺疾病所致呼吸衰竭的临床研究

目的探讨有创与无创序贯性机械通气在慢性阻塞性肺疾病（COPD）所致呼吸衰竭患者救治中的方法与疗效。方法对41例COPD呼吸衰竭患者进行气管插管并施行机械通气,出现HC窗后,随机分为序贯治疗组（21例）和对照组（20例）。序贯组治疗方法：出现PIC窗后,立即拔出气管插管,改用口鼻面罩双水平气道正压通气（BiPAP）。对照组治疗方法：出现HC窗后,继续按常规有创机械通气方法治疗,按临床常用压力支持通气（PSV）模式脱机。两组同时进行监护,观察两组患者VAP发生例数、有创通气时间、总机械通气时间、ICU监护时间、住院时间、住院费用和院内死亡例数。结果序贯组与对照组比较,VAP发生少,有创通气时间、总通气时间、ICU监护时间及住院时间短,住院费用减少（P〈0．05）,差异有统计学意义。结论在“肺部感染控制窗”指导下的有创一无创序贯性脱机治疗方法,可以明显降低VAP发病率,缩短机械通气,ICU和总住院时间,提高疗效,降低治疗费用,是具有一定临床实用价值的有效脱机方案。     

气道分级管理应用于慢性阻塞性肺疾病机械通气患者的效果分析

目的评价慢性阻塞性肺疾病患者机械通气期间采用气道分级管理的干预效果。方法按患者入科顺序将65例患者分为观察组33例和对照组32例。对照组按常规气道管理,每2h予胸部物理治疗;观察组按气道评分实施气道分级管理,行不同频次物理治疗。比较两组机械通气第5天、第10天的潮气量、呼吸频率、动脉血二氧化碳分压及急性生理与慢性健康评分,比较两组机械通气时问和住院时间。结果机械通气第10天,观察组潮气量、呼吸频率、动脉血二氧化碳分压的监测值优于对照组,急性生理与慢性健康评分低于对照组,机械通气时间明显少于对照组,经比较,差异均有统计学意义;两组住院时间比较,差异无统计学意义。结论气道分级管理能有效改善慢性阻塞性肺疾病机械通气患者的呼吸功能。