无创机械通气在重症呼吸衰竭伴意识障碍患者治疗中的应用效果分析

目的分析无创机械通气在重症呼吸衰竭伴意识障碍患者治疗中的应用效果。方法选取2010年1月—2014年1月安福县人民医院收治的慢性阻塞性肺疾病(COPD)合并重症呼吸衰竭患者50例,根据患者是否伴意识障碍分为观察组〔格拉斯哥昏迷评分(GCS)10分〕24例和对照组(GCS≥10分)26例。两组患者均行无创机械通气治疗,比较两组患者治疗情况和治疗前后动脉血气分析指标变化,包括PaO2、PaCO2和pH值。结果两组患者无创机械通气救治成功率比较,差异无统计学意义(79.1%比80.7%,P0.05)。两组患者治疗前后PaO2、PaCO2及pH值比较,差异无统计学意义(P0.05)。两组患者治疗后PaO2和pH值高于治疗前,PaCO2低于治疗前(P0.05)。结论无创机械通气对重症呼吸衰竭伴或不伴意识障碍患者的治疗效果类似,可以改善患者血气分析指标。     

双水平气道正压通气在慢性阻塞性肺疾病呼衰并神志障碍患者中的应用研究

目的研究双水平气道正压无创通气在慢性阻塞性肺疾病(COPD)急性加重期Ⅱ型呼吸衰竭并神志障碍患者中的应用,以及COPD急性加重期Ⅱ型呼吸衰竭在不同程度的神志障碍时双水平气道正压(BiPAP)无创通气的疗效有无差异性。方法95例患者依据是否伴有神志障碍分为两组根据Glascow昏迷评分(GCS)将伴神志障碍组分层。两组均接受BiPAP无创通气,观察通气前、通气后4小时、24小时和72小时的神志变化、GCS评分和血气分析,比较BiPAP无创通气在各层的疗效。结果经BiPAP治疗,伴神志障碍组患者总有效率85%(34/40)。不伴神志障碍组治疗有效率为86.4%,两组差异无显著性(P>0.105);两组经治疗后PaCO2均明显下降,pH值上升。轻度神志障碍、中度神志障碍、重度神志障碍各层BiPAP无创通气的疗效分别为81.8%、92.3%和81.2%。结论BiPAP无创通气可有效治疗COPD呼吸衰竭并神志障碍的患者。神志障碍程度不同,双水平无创正压通气的疗效有所差异,轻度神志障碍、重度神志障碍患者疗效较中度神志障碍患者低。     

无创正压通气治疗COPD合并急性高碳酸血症性脑病的临床研究

目的:评价无创正压通气(NIPPV)治疗慢性阻塞性肺疾病(COPD)呼吸衰竭合并急性高碳酸血症性脑病(AHE)的有效性和安全性。方法:COPD呼吸衰竭合并AHE患者35例,在给予常规治疗的同时,使用口鼻面罩接受NIPPV治疗,监测患者的急性生理与慢性健康评分(APACHEIII)、意识状态评分(GCS)及通气参数,并作血气分析(ABG)测定。结果:所有患者在接受NIPPV治疗1h后氧合(PaO2/FiO2)明显增高(141±27vs183±31,P<0.05),动脉血二氧化碳分压(PaCO2)和GCS评分有所改善。其中,10例患者在NIPPV治疗24h内因意识障碍加重而接受气管插管,其余25例(71.4%)在接受NIPPV治疗12h后神志逐步转清,24h后GCS评分均超过10,与治疗前比较,显著改善(11.2±0.7vs8.9±1.3,P<0.05)。NIPPV治疗7d后,患者GCS评分均恢复至14~15,PaCO2则降至稳定期水平;APACHEIII评分、浅快呼吸指数(RSBI)和吸气压力(PS)也显著降低。结论:应用NIPPV能成功治疗COPD呼吸衰竭继发AHE患者。GCS评分>8的AHE患者在持续NIPPV治疗24h后,GCS评分可显著增高,意识逐步转清,从而避免气管插管。     

双水平气道正压通气在慢性阻塞性肺疾病呼衰并神志障碍患者中的应用研究

目的研究双水平气道正压无创通气在慢性阻塞性肺疾病（COPD）急性加重期Ⅱ型呼吸衰竭并神志障碍患者中的应用，以及COPD急性加重期Ⅱ型呼吸衰竭在不同程度的神志障碍时双水平气道正压（BiPAP）无创通气的疗效有无差异性。方法95例患者依据是否伴有神志障碍分为两组根据Glascow昏迷评分（GCS）将伴神志障碍组分层。两组均接受BiPAP无创通气，观察通气前、通气后4小时、24小时和72小时的神志变化、GCS评分和血气分析，比较BiPAP无创通气在各层的疗效。结果经BiPAP治疗，伴神志障碍组患者总有效率85％（34／40）。不伴神志障碍组治疗有效率为86．4％，两组差异无显著性（P〉0．105）；两组经治疗后PaCO2均明显下降，pH值上升。轻度神志障碍、中度神志障碍、重度神志障碍各层BiPAP无创通气的疗效分别为81．8％、92．3％和81．2％。结论BiPAP无创通气可有效治疗COPD呼吸衰竭并神志障碍的患者。神志障碍程度不同，双水平无创正压通气的疗效有所差异，轻度神志障碍、重度神志障碍患者疗效较中度神志障碍患者低。     

老年慢性阻塞性肺疾病合并重症呼吸衰竭的无创机械通气治疗

无创机械通气治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭已显现出越来越重要的作用。2002年4月至2004年8月，我院呼吸科应用无创机械通气治疗COPD合并重症呼吸衰竭且伴有意识障碍（肺性脑病）的老年患者21例，受到了良好的效果，现报道如下。     

无创正压机械通气对慢性阻塞性肺疾病急性加重期呼吸衰竭的救治

目的进一步评价和认识无创正压机械通气在救治慢性阻塞性肺疾病(COPD)严重呼吸衰竭中的地位和作用。方法前瞻性研究了25例COPD急性加重期患者,均伴有严重的Ⅱ型呼吸衰竭(PaCO2>80mmHg),应用无创双水平正压通气治疗,监测血气、通气参数、临床转归等情况。结果无创机械通气治疗有效22例,治疗开始后1小时血气无明显改变,3小时PaCO2显著下降(P<0.05),pH值上升(P<0.05),病情改善。其中少数患者PaCO2>100mmgH、或伴有昏迷,无创通气抢救成功。患者对鼻面罩及正压通气接受性良好,副作用少。结论无创机械通气为抢救COPD合并呼吸衰竭提供了有效的手段。     

无创通气治疗COPD合并重症呼吸衰竭的作用

目的评价无创通气治疗慢性阻塞性肺疾病(COPD)合并重症呼吸衰竭的价值。方法45例COPD合并重症呼吸衰竭患者随机分为两组:常规治疗+无创通气组(A组)和常规治疗组(B组)。A组30例在常规治疗的同时采用B iPAP呼吸机进行辅助通气。B组15例患者给予常规治疗。结果45例COPD合并急性重症呼吸衰竭的病人中,A组24 h神志明显改善,PaCO2明显下降。治疗组的插管率、死亡率及住院时间均低于对照组,差异有显著性。结论无创通气为COPD合并呼吸衰竭进一步的治疗提供了宝贵的时间,大大提高了生存率。     

间歇负压通气治疗重症COPD患者急性呼衰时的呼吸肌功能不全

本文研究间歇负压通气(INPV)对重症COPD患者急性呼衰时呼吸肌疲劳的作用.患者与方法9(男8,女1)例伴有急性呼衰(ARF)的重症COPD 患者并伴有明显的呼吸肌疲劳(A 组),平均年龄61±7.7岁.借助铁肺进行间歇负压通气(INPV)。压力-50～-60cmH_2O,保证获得>500ml 的潮气量,频率15次/min,待患者清醒后改为间歇通气,2 h/次,8 h/d,连用7日.治疗前和后7日分别检测肺功能和血气.对照(B)组为7例伴有慢性呼衰(CRF)的COPD 患者(男5,女2例),平均年龄61±6.6岁.两组临床症状     

老年慢性阻塞性肺疾病合并重症呼吸衰竭的无创机械通气治疗

无创机械通气治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭已显现出越来越重要的作用。2002年4月至2004年8月,我院呼吸科应用无创机械通气治疗COPD合并重症呼吸衰竭且伴有意识障碍(肺性脑病)的老年患者21例,受到了良好的效果,现报道如下。1资料与方法1.1临床资料本组COPD合并重症呼吸衰竭(肺性脑病)的老年患者21例,男性14例,女性7例;年龄65~83岁,平均75岁。诊断按《慢性阻塞性肺疾病诊治指南》的诊断标准[1]。21例中昏迷17例,燥动4例。其中3例伴有多脏器功能衰竭。动脉血气分析:PaO2<45mmHg(1mmHg=0.133kPa),PaCO2>90mmHg,pH<7.25。1.2…     

慢性阻塞性肺疾病呼吸衰竭机械通气脱机策略

目的 探讨COPD呼吸衰竭有创机械通气脱机策略.方法 机械通气治疗COPD呼吸衰竭108例,分析治疗结果.结果 106例患者成功脱机、拔管,抢救成功率达98％.结论 采取恰当有创机械通气脱机策略,有较高抢救成功率.     

Effects of intermittent negative pressure ventilation on respiratory muscle function in patients with severe chronic obstructive pulmonary disease

The reduced respiratory muscle strength and increased work of breathing in patients with severe chronic obstructive pulmonary disease (COPD) may predispose these patients to the development of respiratory muscle fatigue and consequent respiratory failure. To test the hypothesis that these patients may be experiencing chronic respiratory muscle fatigue, we studied the effects of resting the respiratory muscles in a group of patients with severe COPD. Fifteen stable patients with severe COPD were randomized into study and control groups. In 8 study group patients (Group B), breathing was assisted with a negative pressure ventilator 3 to 6 h daily for 3 consecutive days. The remaining 7 patients served as controls (Group A) and did not receive any intervention. Baseline lung function was evaluated by spirometry and arterial blood gas determinations. Respiratory muscle strength and endurance were evaluated by maximal inspiratory and expiratory pressures (MIP and MEP, respectively) and the maximal duration that isocapnic hyperventilation equal to 50 and 70% of the 12-s maximal voluntary ventilation could be sustained (DSV). Baseline DSV was determined as the best effort of several practice trials. All measurements were repeated on the final day of assisted ventilation approximately 2 to 3 h after its discontinuation. After assisted ventilation, the DSV at 50 and 70% of the maximal voluntary ventilation improved significantly (p less than 0.05). Maximal inspiratory pressure and MEP increased to 114% (p less than 0.05) and 112% (p = 0.05) of baseline values, respectively. Mean arterial PCO2 in the hypercapnic subgroup of Group B patients decreased from 60 mm Hg before to 52 mm Hg after assisted ventilation (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)     

慢性阻塞性肺疾病撤机困难呼吸力学特征10例分析

目的为提高慢性阻塞性肺疾病(COPD)患者撤机成功率提供生理学依据。方法检测2006年1月至2009年12月广州医学院第一附属医院收治的10例撤机困难COPD患者的呼吸力学指标,观察患者自主呼吸(SB)及机械通气时的呼吸力学指标变化。结果 SB时的呼吸频率(RR)、潮气量(VT)和分钟通气量(Ve)分别为(27.94±8.23)次/min、(0.266±0.107)L和(6.843±1.333)L/min,机械通气时的RR降低,而VT和Ve时升高(均P<0.05)。SB和机械通气时的动态内源性呼吸末正压分别为(0.82±0.19)kPa和(0.41±1.12)kPa,SB时明显增高(P<0.01),吸气中期气道阻力(RL)(2.43±0.94)kPa/(L.S)。SB时的P0.1为(0.61±0.16)kPa。SB时的最大跨膈压、最大食管负压和最大吸气口腔压分别为(5.08±0.93)kPa、(-5.00±0.95)kPa和(-3.78±0.86)kPa。SB时跨膈压(Pdi)和吸气压力时间乘积(PTPins)分别为(0.82±0.20)kPa和(48.93±11.94)kPa.s;机械通气时较SB显著降低,分别为(0.67±0.17)kPa和(30.33±11.72)kPa.s(P均<0.05)。结论撤机困难COPD患者存在显著的呼吸力学异常,SB时呼吸浅快,动态内源性呼吸末正压、RL与呼吸中枢驱动等均增高,吸气肌肉无力;应用PSV(1.57 kPa)联合PEEP(48%动态内源性呼吸末正压)可降低约50%的动态内源性呼吸末正压、17.8%的Pdi和38%的PTPins。     

无创正压机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭失败的预测因素分析

目的分析应用无创正压机械通气（NIPPV）治疗慢性阻塞性肺疾病（COPD）合并呼吸衰竭失败的相关因素,为NIPPV的临床应用提供预测指标。方法将NIPPV治疗的236例COPD呼吸衰竭患者分为成功组、早期失败组和晚期失败组,监测患者生命体征指标和通气前、通气2h后血气分析及呼出气潮气量（ETV）指标,其他预测指标分析包括：患者年龄、性别、基础疾病严重程度和患者早期通气依从性、应用面罩耐受性、上机后开始床旁监测、护理时间。基础疾病严重程度采用急性生理与慢性健康状况评分（APACHEⅡ）,意识障碍程度采用Glasgow昏迷指数（GCS）,患者营养状况采用血清白蛋白（Alb）浓度表示。结果NIPPV治疗COPD合并呼吸衰竭成功率为72．0％。早期失败40例、晚期失败26例,总失败率为28．O％。在早期通气依从性、对面罩耐受性方面成功组均明显好于早、晚期失败组;初次使用呼吸机监测、护理时间,早、晚期失败组均低于成功组;在APACHEⅡ评分中早、晚期失败组明显高于成功组;在GCS、Alb方面成功组明显高于早、晚期失败组,通气前早、晚期失败组患者pH值明显低于成功组,呼吸频率（RR）明显高于成功组,而PaO2、PaCO2、ETV在通气前三组之间没有显著差异。与早期失败组不同,在通气2h后成功组,晚期失败组pH、PaO2、PaCO2、ETV较通气前明显改善。结论NIPPV虽已成为COPD呼吸衰竭的一线治疗方法,但正确判断疾病的严重程度、评估治疗前后的病情变化、预测NIPPV成功指标和危险因素,对临床合理应用NIPPV尤为重要。     

无创正压通气治疗慢性阻塞性肺疾病呼吸衰竭伴意识障碍的疗效观察

目的观察无创正压通气（NPPV）治疗慢性阻塞性肺疾病（COPD）呼吸衰竭伴意识障碍患者的疗效。方法将入选的16例COPD呼吸衰竭伴意识障碍患者分为A组,16例意识障碍不明显患者分为B组。在常规治疗的基础上行双水平无创正压通气（BiPAP）,动态观察治疗前后动脉血气、Glasgow昏迷评分、NPPV天数、住院天数、最高IPAP、NPPV成功率、住院病死率及不良反应情况。结果 A组NPPV成功率和住院病死率分别为68.75%（11/16）和18.75%（3/16）,B组分别为81.25%（13/16）和12.5%（2/16）,差异无统计学意义（P均〉0.05）。A组最高IPAP均值较B组高6 cmH2O,且NPPV和总住院时间也较B组长3和7 d（P〈0.05或P〈0.01）。A组胃肠胀气和面部皮肤损伤较B组发生率高（68.75%比18.75%,25.0%比6.25%,P〈0.05）。结论 NPPV对COPD呼吸衰竭伴意识障碍患者也有较好的疗效,意识障碍不是NPPV治疗的绝对禁忌症。     

Respiratory muscle fatigue limiting physical exercise?

Inspiratory muscle fatigue has been documented during loaded breathing or acute respiratory failure, but its role in exercise limitation is still undetermined. Electromyographic (EMG) signs of diaphragmatic fatigue develop in normal subjects hyperventilating above 70% of maximal voluntary ventilation (MVV), a ventilatory level commonly attained at peak exercise. EMG signs of diaphragmatic fatigue also occur during high power cycling exercise in normal subjects and chronic obstructive pulmonary disease (COPD) patients. However, a loss of respiratory muscle strength has rarely been documented following strenuous physical exercise with techniques independent of the subjects' collaboration. Prior inspiratory muscle fatigue decreases exercise tolerance in normal subjects but its effect is largely unknown in COPD patients. Respiratory muscle rest by negative pressure ventilation was reported to improve exercise tolerance in COPD, but this beneficial effect was not confirmed by controlled studies. The effect of inspiratory muscle training on exercise tolerance is still undefined by existing data, in part because of differences in methods and selection criteria between studies. Although respiratory muscle fatigue may occur during exercise, it is not clearly established whether interventions directed at respiratory muscles may improve exercise tolerance in COPD.     

有创与无创序贯机械通气治疗慢性阻塞性肺疾病重症呼吸衰竭

目的探讨有创与无创序贯机械通气治疗慢性阻塞性肺疾病（COPD）重症呼吸衰竭的方法与疗效。方法对40例COPD重症呼吸衰竭患者进行气管插管机械通气治疗，达到肺部感染控制窗（PIG窗）后，随机分为序贯治疗组和对照组，每组20例。序贯组治疗方法：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：继续按常规有创机械通气方法治疗，以目前临床常用压力支持通气（PSV）模式脱机、2组同时进行监护，观察2组患者有创通气时间、呼吸机相关肺炎（VAP）发生例数、总机械通气时间、住院时间、监护时间、病死率等。结果2组患者发生VAP的例数分别为1例（5％）和8例（40％）（P〈0．05），总机械通气时间分别为（10．4±2．5）d和（15．3±3．2）d（P〈0．05），住院时间分别为（16．2±2．8）d和（25．8±4．2）d（P〈0．01）。结论在PIC窗指导下的有创与无创序贯性通气治疗方法，可以明显缩短机械通气时间，降低VAP发生率，缩短重症监护（ICU）和总住院时间，改进治疗效果，降低治疗费用，提高抢救成功率。     

Diaphragmatic energy expenditure in chronic respiratory failure. The effect of assisted ventilation with body respirators.

Patients with chronic respiratory failure secondary to disorders which increase the work of breathing often benefit from assisted ventilation with body respirators. To test the hypothesis that body respirator therapy works by relieving the respiratory muscles of an excessive load, we recorded diaphragmatic and/or accessory inspiratory muscle electrical activity before and during assisted ventilation in 11 patients. All patients had chronic hypercapnia; seven had advanced obstructive pulmonary disease and four had severe thoracic cage restriction.     

不同切换时机的序贯机械通气治疗慢性阻塞性肺疾病合并呼吸衰竭临床效果的网状Meta分析

背景 序贯机械通气是治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭的强有力手段,其治疗关键是选择恰当的切换时机,但目前切换时机的界定标准尚未统一.目的 采用网状Meta分析方法比较不同切换时机的序贯机械通气治疗COPD合并呼吸衰竭患者的临床效果,旨在为序贯机械通气切换时机的选择提供参考.方法 计算机检索PubMed、We...     

Ventilatory muscle support in respiratory failure with nasal positive pressure ventilation

Long-term intermittent mechanical ventilation results in improvements in ventilatory performance and clinical status between ventilation sessions in patients with chronic respiratory failure. The application of intermittent positive pressure ventilation through a nasal mask (NPPV) is a simple, noninvasive method for the provision of chronic intermittent ventilatory support. We investigated the effects of NPPV on inspiratory muscle activity in three normal subjects and nine patients with acute or chronic ventilatory failure due to restrictive (four subjects) or obstructive (five subjects) respiratory disorders. NPPV resulted in reductions of phasic diaphragm electromyogram amplitude to 6.7 +/- 0.7 percent (mean +/- SEM) of values obtained during spontaneous breathing in the normal subjects, 6.4 +/- 3.2 percent in the restrictive group, and 8.3 +/- 5.1 percent in the obstructive group. Simultaneous decreases in activity of accessory respiratory muscles were observed. The reductions in inspiratory muscle activity were confirmed by the finding of positive intrathoracic pressure swings on inspiration in all subjects. With NPPV, oxygen saturation and PCO2 remained stable or improved as compared with values obtained during spontaneous breathing. These results indicate that NPPV can noninvasively provide ventilatory support while reducing inspiratory muscle energy expenditure in acute and chronic respiratory failure of diverse etiology. Long-term assisted ventilation with NPPV may be useful in improving ventilatory performance by resting the inspiratory muscles.     

The pattern of respiratory muscle recruitment during pursed-lip breathing.

Data from the present study indicate a change in the pattern of chest wall muscle recruitment and improved ventilation with pursed-lip breathing (PLB) in COPD. Pursed lip breathing led to increased rib cage and accessory muscle recruitment during inspiration and expiration, increased abdominal muscle recruitment during expiration, decreased duty cycle of the inspiratory muscles and respiratory rate, and improved SaO2. In addition, PLB resulted in no change in pressure across the diaphragm and a less fatiguing breathing pattern of the diaphragm. Changes in chest wall muscle recruitment and respiratory temporal parameters concomitant with the increased SaO2 indicate a mechanism of improving ventilation with PLB while protecting the diaphragm from fatigue in COPD. Alterations in the pattern of respiratory muscle recruitment with PLB may be associated also with the amelioration of dyspnea. Further investigation is necessary to explore the relationship between the pattern of respiratory muscle recruitment during PLB and dyspnea.