呼吸机面罩通气用于气管插管前的效果观察

目的比较呼吸机面罩通气和简易呼吸器面罩通气在ICU紧急床旁气管插管前的应用效果。方法采取临床随机对照研究,对符合纳入标准的100例需紧急气管插管的患者,按入住ICU顺序编号,并根据随机数字表法,分为两组,每组50例。在气道开放后,辅助通气间,观察组使用呼吸机面罩通气,对照组使用简易呼吸器面罩通气,监测两组患者SPO2开始上升所需时间、上升达目标值(SPO2≥95%)所需时间;比较两组患者在气管插管过程中心率、血压的变化情况;分析两组患者插管前、后血气分析的变化情况。结果观察组SPO2开始上升时间及达目标值所需时间均低于对照组,差异有统计学意义(P0.05)。在插管过程中,观察组心率、血压升高的例数低于对照组,差异有统计学意义(P0.05)。血气分析结果显示:观察组插管后,PaO2高于对照组,PaCO2低于对照组,差异有统计学意义(P0.05)。观察组插管后,PaO2、高于插管前,PaCO2低于插管前,差异有统计学意义(P0.05)。结论呼吸机面罩通气,供氧浓度100%;潮气量确切可靠,气道峰压控制准确,PEEP适宜,能快速改善机体缺氧状态,增加机体组织氧气储备,更能耐受无通气期的气管插管;优化了抢救流程,减少并发症的发生,和呼吸器面罩通气相比较,具有明显的优势。     

重型颅脑损伤患者气管插管内呼吸机相关临床病原学的研究

目的 :了解重型颅脑损伤气管插管内呼吸机相关病原学问题。方法 :对 30例重型颅脑损伤患者在拔除气管插管时 ,以插管套管内、口腔、螺纹管内分泌物进行细菌学研究 ,并作统计学处理。结果 :1在 30例重型颅脑损伤病例中气管插管内有 5 6 %患者出现致病菌 ;2病原菌以 G- 杆菌为主 ,但真菌上升至第 2位 ;3在重型颅脑伤病情中 ,随病情加重〔即格拉斯哥昏迷评分 (GCS)评分下降〕,致病菌发生率会增加 ;4特重型颅脑伤致病菌发生率明显高于重型颅脑伤 ;5插管的时间长短与并发肺炎的早晚无确定关系。结论 :1在重型颅脑伤患者气管插管中均可产生较高比率的致病菌 ;2预防重型颅脑伤所致的肺炎应选择 G-杆菌敏感抗生素 ;3预防真菌感染及机内消毒是一个重要措施 ;4及时拔管 ,变更通气方式 ,有利于减少致病菌的产生     

机械通气患者洗胃插管方法的探讨

农药或药物中毒患者病情凶险,入院时或在洗胃的过程中部分患者出现呼吸衰竭甚至呼吸心跳停止,此类患者通常施行气管插管后心肺复苏的同时需紧急插管洗胃,以达到尽快排除毒物的目的。按传统插管法,洗胃管难以置入,紧急情况下往往需要胃造瘘或胃切开洗胃,延长了开始洗胃的时间,增加了救治难度。为此,2001年5月~2004年11月我科对14例口服有机磷农药中毒已行气管插管机械通气的患者采用新的洗胃插管法均获成功,现报告如下。临床资料1·一般资料。2001年5月~2004年11月,口服有机磷农药中毒已行气管插管机械通气的患者14例,男4例,女7例,年龄20~51…     

气管插管后机械通气治疗危重支气管哮喘合并呼吸衰竭的疗效观察

目的探讨气管插管后机械通气对危重支气管哮喘合并呼吸衰竭的疗效。方法回顾性分析2002年1月~2008年4月收治的17例危重支气管哮喘合并呼吸衰竭患者,采用气管插管后机械通气。通气模式:同步间歇指令通气(SIMV)加低水平呼气末正压(PEEP)。根据患者病情及时调整呼吸机参数及考虑撤机,观察机械通气治疗前后血气及相关临床资料。结果机械通气治疗后,临床症状、体征改善明显,pH值、PaO2、PaCO2均恢复正常,顺利撤除呼吸机,与治疗前比较差异均有显著性意义(P<0.01)。结论危重支气管哮喘合并呼吸衰竭采用经气管插管后机械通气技术治疗效果确切,能迅速纠正呼吸衰竭,缓解临床症状,改善动脉血氧分压和通气,并能在短期内顺利撤机,值得临床推广。     

双水平无创呼吸机在气管插管患者拔管前的应用及护理

探讨无创呼吸机在气管插管患者拔管前的应用及护理.对31例气管插管患者在机械通气序贯脱机过程中,采用在拔除气管导管前先给予具有双水平的自主呼吸与时间控制(ST)模式的无创呼吸机进行治疗,待患者适应后再拔除气管导管,拔管后继续给予无创呼吸机治疗.31例中有29例脱机成功,脱机成功率为93.6％.气管插管患者在有创无创呼吸机序贯治疗过程中,拔除气管导管前先给予无创呼吸机治疗后再拔管,可以提高有创呼吸机的脱机成功率.     

Noninvasive mechanical ventilation in acute cardiogenic pulmonary edema

Acute cardiogenic pulmonary edema is a frequent life-threatening emergency. During the last 10 years, increasing attention has focused on the use of noninvasive ventilation to treat patients with various forms of acute respiratory failure. Numerous physiologic data and clinical studies support the use of noninvasive ventilation during cardiogenic pulmonary edema. Noninvasive ventilation results in rapid improvement of clinical signs of respiratory distress and gas exchange and decreases the need for endotracheal intubation for patients in the ICU with acute hypercapnic respiratory failure related to cardiogenic pulmonary edema. However, no sustained benefit (, decreased late mortality) or benefit for less severe forms of cardiogenic pulmonary edema has been demonstrated yet. Moreover, there are still few data that support the use of a specific mode of ventilation over the others.     

有创机械通气患者体位改变插入胃管效果分析

目的提高有创机械通气患者插入胃管的成功率,减少因反复插管所致的并发症,减轻患者痛苦,提高护士的工作效率。方法将需建立人工气道并进行机械辅助通气的100例患者随机分为观察组和对照组各50例,观察组采取改变常规的“去枕头后仰位”为“抬高床头70°~80°角头正位”插入胃管,对照组采取常规的去枕头后仰卧位方法插入胃管。结果对照组一次插管成功率为6.0%,观察组一次插管成功率为94.0%,两组比较,差异有统计学意义(P<0.01)。结论抬高床头70°~80°角头正位”插入胃管简便易行,省时省力,既减轻对患者的刺激,又可减少因反复对患者插胃管所致的局部黏膜损伤、充血水肿等并发症,减轻了患者痛苦,也极大地提高了护士的工作效率。     

Effects of acupressure therapy for patients having prolonged mechanical ventilation support

AIMS: This paper reports an investigation of the effects of acupressure therapy on dyspnoea, anxiety and physiological indicators of heart rate and respiratory rate in patients with chronic obstructive pulmonary disease having mechanical ventilation support. BACKGROUND: Patients with chronic obstructive pulmonary disease who are using mechanical ventilation often experience dyspnoea and anxiety, which affects successful ventilator use. METHODS: The study had an experimental blocking design, using sex, age and length of ventilator use as a blocking factor. Qualified patients in two intermediate respiratory intensive care units were randomly assigned to an acupressure group and a comparison group. A total of 52 patients with chronic obstructive pulmonary disease in northern Taiwan participated. Those in the experimental group received daily acupressure therapy and massage treatment for 10 days. Patients in the comparison group received massage treatment and handholding. The primary outcome measures were the visual analogue scales for dyspnoea and anxiety, and physiological indicators of heart rate and respiratory rate. Data were collected every day from baseline (day 1), during the treatment (days 2-10) and follow-up (days 11-17). Data were analysed using generalized estimation equations. The study was carried out in 2003. RESULTS: Patients with chronic obstructive pulmonary disease who were using prolonged mechanical ventilatory support experienced high levels of dyspnoea and anxiety. Dyspnoea (P = 0.009), anxiety (P = 0.011) and physiological indicators (P < 0.0001) in the acupressure group improved statistically significantly over time when compared with those of the comparison group. CONCLUSIONS: This results support the suggestion that acupressure therapy could decrease sympathetic stimulation and improve perceived symptoms of dyspnoea and anxiety in patients with chronic obstructive pulmonary disease who are using prolonged mechanical ventilation.     

组合式气管导管在机械通气中的应用研究

目的 探讨组合式气管导管声门下引流对机械通气时呼吸机相关性肺炎(VAP)的影响.方法 将需要气管插管机械通气48 h以上的患者随机分为两组,A组采用普通气管导管,B组采用组合式气管导管并定期行声门下引流.观察两组间患者VAP的发生情况并做统计学分析.结果 治疗A组VAP的发生率明显高于治疗B组.结论 避免VAP的危险因素是降低VAP发生率行之有效的措施.组合式气管导管的临床应用能有效地清除声门下分泌物,降低细菌在呼吸道定植率,是预防VAP比较有效的措施.     

Noninvasive mechanical ventilation may be useful in treating patients who fail weaning from invasive mechanical ventilation: a randomized clinical trial

Introduction  

The use of noninvasive positive-pressure mechanical ventilation (NPPV) has been investigated in several acute respiratory failure situations. Questions remain about its benefits when used in weaning patients from invasive mechanical ventilation (IMV). The objective of this study was to evaluate the use of bi-level NPPV for patients who fail weaning from IMV.     

改进吸痰法在气管插管机械通气患者中的应用效果观察

目的探讨改进吸痰法在气管插管机械通气患者中的应用效果观察。方法将行气管插管机械通气的120例患者,按照随机数字表法分为试验组和对照组,每组各60例,试验组采用改进吸痰法,包括气管导管内（浅部）吸痰、气管导管外（深部）及气囊上方吸痰3部分;对照组采用常规吸痰法。两周后观察两组患者气道黏膜损伤及呼吸机相关性肺炎（ventilator-associated pneumonia,VAP）的发生情况。结果试验组和对照组患者气道黏膜损伤发生率比较,差异具有统计学意义（1.7%vs16.7%,χ2=8.107,P〈0.01）;试验组和对照组患者VAP的发生率比较,差异具有统计学意义（3.3%vs18.3%,χ2=6.988,P〈0.01）。结论改进吸痰法在气管插管机械通气患者中的应用,不仅降低了患者气道黏膜的损伤,同时还降低了VAP的发生,值得临床推广应用。     

Noninvasive monitoring of lung function during mechanical ventilation

Noninvasive monitoring can greatly enhance decision-making and clinical approaches to the respiratory failure patient. Newer microprocessor systems will calculate, present, and trend derived data such as airway resistance and lung-thorax compliance. These changes characterize the degree of lung dysfunction and parallel abnormalities in gas exchange.     

Noninvasive interface for transtracheal mechanical ventilation for patients with severe cervical spine deformity

This article describes a custom-molded patient-to-ventilator interface that permits mechanical ventilation via a tracheostomy site for patients for whom tracheostomy tubes can not be used because of severe cervical deformity. The nocturnal delivery of intermittent positive-pressure ventilation resulted in normalization of oxyhemoglobin saturation and end-tidal CO2 and alleviation of symptoms of alveolar hypoventilation. Thermoplastic patient-ventilator tubing interfaces can be constructed to permit ventilatory assistance for patients with tracheostomies who can not use tracheostomy tubes.     

气管插管机械通气患者拔管后获得性吞咽功能障碍危险因素分析

目的 分析气管插管机械通气患者拔管后获得性吞咽功能障碍的相关危险因素.方法 选择2018年2月-2020年6月我院气管插管行机械通气患者79例为研究对象.收集患者一般资料、疾病相关资料、插管相关资料,采用标准吞咽功能评估量表(SSA)评估吞咽功能障碍发生情况.应用单因素分析、多因素Logistic回归分析吞咽功能障碍的...     

Successful use of nasal BiPAP in three patients previously requiring intubation and mechanical ventilation

Noninvasive mask ventilation may be used to treat patients with impending respiratory failure. In this case series, three patients with severe chronic obstructive pulmonary disease, who required mechanical ventilation in the past, were successfully treated with nasal bi-level positive airway pressure (BiPAP). All patients tolerated BiPAP well without complications. Therefore, nasal BiPAP may be considered a treatment option for patients with severe COPD who have previously required intubation and mechanical ventilation.     

Noninvasive ventilation in patients with acute hypercapnic exacerbation of chronic obstructive pulmonary disease who refused endotracheal intubation

OBJECTIVE: To determine the long-term outcome of noninvasive ventilation in chronic obstructive pulmonary disease patients who refused intubation for acute hypercapnic respiratory failure. DESIGN: Prospective, observational study. SETTING: Noninvasive ventilation unit in an acute regional hospital in Hong Kong. METHODS: The study recruited 37 chronic obstructive pulmonary disease patients who had the do-not-intubate code and developed acute hypercapnic respiratory failure. They were offered noninvasive ventilation, and their long-term outcomes were followed. Survival and event-free survival (an event is death or recurrent acute hypercapnic respiratory failure) were analyzed by survival analysis. Their disease profile and outcome were compared with another 43 chronic obstructive pulmonary disease patients without the do-not-intubate codes, who had acute hypercapnic respiratory failure and received noninvasive ventilation during the study period (usual care group). RESULTS: Patients in the do-not-intubate group were significantly older (p =.029), had worse dyspnea score (p <.001), worse Katz Activities of Daily Living score (p <.001), worse comorbidity score (p =.024), worse Acute Physiology and Chronic Health Evaluation II score (p =.032), lower hemoglobin (p =.001), and longer stay in the hospital during the past year (p =.001) than patients who received usual care. In the do-not-intubate group, the median survival was 179 days, and 1-yr actuarial survival was 29.7%; in the usual care group, the median survival was not reached during follow-up, and 1-yr actuarial survival was 65.1% (p <.0001). In the do-not-intubate group, the median event-free survival was 102 days, and 1-yr event-free survival was 16.2%; in the usual care group, median event-free survival was 292 days, and 1-yr event-free survival was 46.5% (p =.0004). CONCLUSIONS: A 1-yr survival of about 30% was recorded in chronic obstructive pulmonary disease patients with the do-not-intubate code who developed acute hypercapnic respiratory failure requiring noninvasive ventilation. The majority of survivors developed another life-threatening event in the following year. Information generated from this study is important to physicians and chronic obstructive pulmonary disease patients when they are considering using noninvasive ventilation as a last resort.     

Retrograde technique for tracheal intubation in trauma patients

Nineteen trauma patients with either maxillofacial trauma or cervical spine fracture were orotracheally intubated over a guidewire percutaneously inserted through the cricothyroid membrane into the mouth in a retrograde fashion. In 13 patients, conventional techniques failed (average number of attempts 6 +/- 1, mean duration 18 +/- 1 min); in six patients, the initial method of choice was a retrograde technique. In all patients, retrograde technique succeeded on only one attempt (duration less than 5 min in all cases). No serious complication could be related to this technique; it is an easy, safe, efficacious method for difficult tracheal intubation in trauma patients.