压力调节容量控制通气对急性呼吸衰竭患者呼吸力学及血流动力学的影响

目的：研究压力调节容量控制（PRVC）通气和容量控制（VC）通气模式对急性呼吸衰竭患者呼吸力学和血液动力学的影响。方法：对26例急性呼吸衰竭患者,采用自身对照的方法,先后予以PRVC和VC两种通气模式各通气2h,更改模式时呼吸机设置参数不变,并测定其血流动力学、呼吸力学及血气分析指标。结果：PRVC模式与VC模式比较,吸气峰压（PIP）、肺动态顺应性（Cst）均有显著差异（P〈0.05）。但两组平均气道压、血流动力学参数、血气分析指标比较均无显著差异（P〉0.05）。结论：PRVC通气模式可明显降低PIP,改善Cst,符合肺保护性机械通气策略的要求。     

压力调节容量控制通气对急性肺损伤血流呼吸动力学和氧代谢的影响

目的研究压力调节容量控制通气(PRVC)和间歇正压通气(IPPV)对急性肺损伤(ALI)患者血流动力学、呼吸动力学和氧代谢的影响.方法对30例ALI患者分别进行呼吸末正压(PEEP)0、5、10 cmH2O水平下的PRVC和IPPV通气,测定其血流动力学、呼吸力学和氧代谢参数.结果比较PRVC和IPPV二种通气模式,同一水平PEEP其血流动力学无明显差异(P＞0.05),但吸气峰压(PIP)、肺动态顺应性(Cst)、动脉氧分压(PaO2)和氧供(DO2)均有明显差异(P＜0.05).结论PRVC与IPPV相比能明显降低PIP,增加Cst,增加DO2.     

压力调节容量控制通气治疗小儿急性呼吸衰竭的临床观察

目的：探讨压力调节容量控制通气（pressure regulated volume control ventilation, prvcv）在治疗小儿呼吸衰竭中的应用效果。方法：34例呼吸衰竭小儿，予压力调节容量控制通气，初调参数：Vt6-8ml／kg，PEEP3～5cmH2O，FiO 20．4-1．0，RR30-40次／min，Ti0．6～0．8s，压力上线水平25～30cmH2O。结果：平均上机时间38．4h，治愈24例，死亡5例，放弃5例。结论：压力调节容量保障通气治疗小儿呼吸衰竭有较好的疗效。同步性能好，可减少或避免应用镇静剂或肌肉松弛剂，缩短上机时间。潮气量恒定，可保障自主呼吸不稳定患儿的通气安全，避免频繁调整吸气压力。吸气流速波为减速波，可减小吸气阻力，降低吸气峰压，减少气压伤。     

压力调节容量控制通气治疗慢性阻塞性肺疾病急性加重期呼吸衰竭疗效分析

目的探讨慢性阻塞性肺疾病急性加重期（AECOPD）患者呼吸衰竭时初始采用压力调节容量控制通气（PRVC）治疗的疗效。方法将10例并发呼吸衰竭需行机械通气治疗的AECOPD患者分为试验组5例以PRVC进行治疗，对照组5例以容量控制（VC）的辅助／控制通气（A／C）治疗，分别于机械通气治疗1、2、4小时观察两组pH、PaO2、PaCO2的变化。结果试验组pH、PaO2、PaCO2的改善明显低于对照组（p〈0．05）。结论AECOPD患者呼吸衰竭行机械通气治疗时初始采用PRVC模式．疗效不及VC（A／C）模式。     

不同控制通气模式对急性呼吸衰竭患者呼吸力学的影响

目的：探讨压力调节容量控制通气（PRVC）与容量控制通气（VC）对急性呼吸衰竭患者呼吸力学和血液动力学的影响。方法急性呼吸衰竭患者32例采用PRVC、VC模式进行治疗,比较两组呼吸力学参数、血流动力学参数及血气分析参数变化。结果 PRVC组PIP明显低于VC组（P<0.05）,而Cst明显高于VC组（P<0.05）,两组在Vt、meanAP及PEEP等方面比较差异无统计学意义（P>0.05）;两组在HR、MAP、CVP等血流动力学参数及pH、PaO2、PaCO2等血气分析参数等方面比较差异无统计学意义（P>0.05）。结论 PRVC模式可明显降低急性呼吸衰竭患者PIP,提高Cst,在防止肺气压伤的发生中发挥重要的临床作用。     

慢性阻塞性肺疾病患者呼吸衰竭应用压力调节容量控制通气治疗及护理效果评价

目的探讨慢性阻塞性肺疾病（COPD）呼吸衰竭初始采用压力调节容量控制通气（PRVC）治疗与护理。方法将38例并发呼吸衰竭需行机械通气治疗的COPD患者随机分为试验组和对照组。试验组以PRVC进行治疗,对照组以容量控制的辅助/控制通气治疗,分别于机械通气治疗1、2、4小时观察两组动脉血酸碱度（pH）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）的变化,记录两组通气治疗4小时内每小时所发生的人机对抗次数。结果在同一观察时间,试验组pH、PaO2、PaCO2的改善明显低于对照组,而4小时内所发生的人机对抗次数多于对照组,差异有统计学意义（P〈0.05）。结论对COPD患者呼吸衰竭行机械通气治疗时初始采用PRVC模式的临床疗效不及容量控制（VC）模式,故初始采用PRVC模式治疗应慎重。     

压力调节容量控制通气治疗危重支气管哮喘探讨

目的探讨压力调节容量控制通气(PRVC)模式治疗急性重症支气管哮喘的效果。方法47例重症哮喘患者被随机分为A组(25例)和B组(22例)。A组予PRVC通气,B组予SIMV PSV通气,比较两组患者治疗前后的动脉血气分析(ABGs)、呼吸力学、通气时间及住ICU时间。结果A组患者在使用机械通气(MV)后,ABGs明显改善(P<0·01),PIP、Pplat较B组降低,Cdyn优于B组,MV时间和住ICU时间均短于B组(P<0·05)。结论PRVC在治疗重症哮喘患者时,能够保持较低的PIP和Pplat,改善ABGs和Cdyn,缩短MV时间以及住ICU时间,是一种安全而有效的通气模式。     

容积标限压力控制通气时吸入沙丁胺醇对呼吸衰竭患者通气参数的影响

目的　探讨在容积标限压力控制 (VTPC)通气时吸入沙丁胺醇后对呼吸衰竭患者通气参数的变化。方法　 2 1例呼吸衰竭患者 ,年龄 (6 7± 4 )岁 ,均接受气管插管与机械通气支持治疗 2 4h以上 ,采用Newporte 5 0 0型呼吸机 ,先实施定容型通气 (VCV) 30min ,潮气量 (VT/Tinflation)。随后转为VTPC通气 30min ,并同样记录上述参数。通过同轴吸入装置吸入沙丁胺醇 6 0 0 μg后重复VCV和VTPC通气 ,并记录上述通气参数。结果　VCV通气时 2 1例患者的系统静志顺应性 (Cst)为 (39 2± 2 4 )ml/cmH2 O ,气道阻力(Raw)为 (19 3± 2 2 )cmH2 O/ (L·S)。VTPC时气道峰压值 (PIP)和VT/Tinflation 较VCV时显著降低 (均P<0 0 5 ) ,PIF则显著增高 ,二种通气时的平台压Pplateau差异无显著性 (2 2 4cmH2 O± 0 9cmH2 O与 2 3 2cmH2 O± 1 2cmH2 O ,P >0 0 5 )。吸入沙丁胺醇后患者的Raw有显著降低 ,而Cst无明显变化 ,VCV时的PIP有所降低 ,但Pplateau无变化 ;VTPC时的PIP和Pplateau与吸入前比较无明显改变 ,PIF由 (4 9 7± 3 0 )L/min增至 (5 3 0± 4 1)L/min (P >0 0 5 ) ,但PEF出现明显增高 (4 2 3L/min± 1 8L/min与 5 2 3L/min± 1 6L/min ,P <0 0 5 ) ,Tinflation则相应缩短 (1 9s± 0 2s与 1 2s± 0 2s,P <0     

压力调节容量控制通气模式在重症胸外伤治疗中的应用

重症胸外伤是临床常见的危重症之一，常并发急性呼吸窘迫综合征（ARDS），机械通气治疗是不可缺少的重要手段。作对压力调节容量控制通气（PRVC）模式进行了相应的临床研究，现探讨PRVC治疗重症胸外伤的临床应用价值。     

压力和容量控制通气在机械通气患者纤维支气管镜操作中的临床观察

目的:探讨压力控制通气(PCV)和容量控制通气(VCV)在机械通气患者纤维支气管镜操作中的临床效果。方法:将2015年5月至2016年9月收治的机械通气中行纤维支气管镜操作的60例患者随机分为PCV组(n=30)和VCV组(n=30),比较操作前及操作中心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、外周氧饱和度(SaO_2)、动脉血氧分压(PaO_2)、气道平台压(Pplat)、气道峰压(Ppeak)、呼气末正压(PEEP)、潮气量(Vt)、肺顺应性(Cdyn)的变化。结果:操作前、后两组患者HR、RR、Ppeak、Pplat、Cdyn及MAP均有明显差异(P<0.05),VCV组操作中Ppeak与操作前对比有明显差异(P<0.05),而PCV组Ppeak操作中与操作前比较无明显差异(P>0.05)。结论:对机械通气患者行纤维支气管镜操作时应用PCV模式对患者肺顺应性影响小,可降低气道峰压和平台压,避免患者生命体征明显波动。     

无创正压通气治疗急性呼吸衰竭失败的相关因素探讨

目的　研究无创正压通气 (NPPV)治疗急性呼吸衰竭 (ARF)失败的相关因素 ,探讨NPPV治疗失败需转换为有创通气的时机。方法　对 74例由各种病因所致ARF接受NPPV治疗患者根据治疗结果分为NPPV失败组和NPPV成功组 ,比较两组患者各项指标变化 ,分析与NPPV治疗失败相关的因素。结果　NPPV治疗失败 2 2例 (2 9 7% )。入院初NPPV失败组的呼吸频率 (RR)和心率 (HR)增快 ,动脉血二氧化碳分压 (PaCO2 )升高和pH下降 ,与NPPV成功组比较差异有显著性 (P <0 0 5 )。Logistic回归分析显示 ,RR >30次 /min ,HR >130次 /min ,PaCO2 >6 0mmHg ,pH <7 30是影响NPPV失败的相关因素。NPPV成功组治疗后 1～ 6h动脉血氧分压 (PaO2 )明显改善 ,与治疗前比较差异显著 (P <0 0 5 )。NPPV失败组治疗后 1～ 6h动脉血气与治疗前比较无明显改善。结论　ARF患者显著异常的RR、HR、PaCO2 和pH是与NPPV治疗失败相关的因素。NPPV治疗初期 (1～ 6h)动脉血气有无显著改善亦可作为预测NPPV治疗成功与否的指标。NPPV治疗失败时及时改用有创通气可降低病死率 ,改善预后。     

吸痰方法对PRVC治疗慢性呼吸衰竭的疗效影响

目的观察不同吸痰方法对压力调节容量控制模式(PRVC)治疗慢性呼吸衰竭的疗效。方法选取2008年3月～2010年3月进行PRVC治疗的36例COPD慢性呼吸衰竭患者,随机分为实验组和对照组,每组18例。实试验组采用改良吸痰方法,对照组采用常规吸痰方法,观察治疗2 h、4 h后动脉血气分析(pH、PaO_2、PaCO_2)的变化。结果治疗2 h、4 h后,实验组的pH、PaO_2升高,PaCO_2明显降低,与对照组相比差异有显著意义,P0.05,P0.01。结论改良吸痰方法有利于增加PRVC治疗的疗效,值得在临床工作中进一步研究。     

急性呼吸衰竭气管插管机械通气患者短期预后影响因素分析

目的　探讨可以评估急性呼吸衰竭 (ARF)机械通气患者短期预后的相关因素。方法　对 116例因各种原因导致ARF行气管内插管机械通气患者资料进行回顾性分析。结果　急性生理评分 (APS)、急性生理和慢性健康估测评分 (A PACHE)Ⅱ评分较高、恶性病、低白蛋白血症、FEV1/FVC比值较大、贫血、机械通气时间 >72h、拔管失败与短期内死亡率升高相关 ;机械通气持续时间超过 72h、APS较高、恶性病以及出现APACHEⅡ相关的疾病为独立预测不良预后的因素。结论　拔管失败或机械通气时间超过 72h提示预后不良 ;机械通气 6h内相应的指标、合并症的出现、急性疾病严重性是行气管内插管机械通气ARF患者住院死亡率的预测指标     

Oxygen tolerance in patients with acute respiratory failure

Objective: To search for a threshold of pulmonary oxygen toxicity in patients with acute respiratory failure. Design: Retrospective study over a 10-year period. Setting: Three intensive care units of two university hospitals. Patients and participants: Seventy-four patients with acute respiratory failure ventilated continuously with a FIO₂ L 0.9 for at least 48 h were selected. Interventions: Information regarding status, scoring, diagnosis and therapeutic interventions upon admission and ICU course were extracted from the patients' charts. Measurements and results: We found that total exposure [mean (standard error of the mean) ] to a FIO₂ of 0.9 (TE 90) or more was 5.6 (1.1) days in the 17 survivors (S) versus 5.9 (0.5) days in the 57 non-survivors (D) (NS). Total exposure time to a FIO₂ more than 0.5 (TE 50) was 16.5 (2.6) days in S and 11.2 (1) days in D (p < 0.05). The PaO₂/FIO₂ ratio became significantly higher in S only 5 days after beginning FIO₂ of 0.9 or more. Hypoxemia was not frequent at the time of death, whereas in 70 % of the non-survivors there were at least three organ failures in the last 48 h. In univariate analysis, the duration of exposure to FIO₂ of 0.9 or more was not different in survivors and non-survivors, and the average total duration of exposure to FIO₂ of more than 0.5 was even longer in survivors. In multivariate analysis, exposure shorter than 10 days to FIO₂ more than 0.5 and exposure longer than 4 days to a FIO₂ of 0.9 or more were significantly associated with death. However, despite a larger exposure to a FIO₂ of 0.9 or more during the last 5 years of the study, the trend moved towards a higher survival rate during this period compared with the first 5 years of the study. Conclusions: Thus, our data provide circumstantial evidence that the lungs of patients with acute respiratory failure might exhibit some relative resistance to prolonged oxygen exposure. Therefore, it might be worthwhile carrying out a prospective study of different FIO₂ strategies in such patients. Received: 14 February 1997 Accepted: 2 March 1998     

无创双水平正压通气对不同病因急性呼吸衰竭的治疗评价

目的：研究无创双水平正压通气(BiPAP)对心源性肺水肿和重症社区获得性肺炎所致呼吸衰竭的治疗效果。方法：49例急性呼吸衰竭患者分为心源性肺水肿组(25例)和重症肺炎组(24例)，均应用BiPAP进行治疗，观察两组的治疗效果。结果：两组患者应用BiPAP治疗后早期氧合均得到明显改善；心源性肺水肿组在BiPAP治疗时间、气管插管率、死亡率方面均明显低于重症肺炎组。结论：无创正压通气在早期可以纠正心源性肺水肿和重症肺炎合并呼吸衰竭患者的氧合，但最终的预后因呼吸衰竭的病理类型不同而有很大区别。     

High-frequency percussive ventilation improves oxygenation and ventilation in pediatric patients with acute respiratory failure

Purpose

High-frequency percussive ventilation (HFPV) in pediatrics has been described predominantly in burned patients. We aimed to describe its effectiveness and safety in noninhalational pediatric acute respiratory failure (ARF).

Methods

We conducted an observational study in a tertiary care pediatric intensive care unit on 31 patients with ARF failing conventional ventilation transitioned to HFPV. Demographics, ventilator settings, oxygenation index, oxygen saturation index, oxygen saturation as measured by pulse oximetry/fraction of inspired oxygen (Fio₂), and Pao₂/Fio₂ were recorded before and during HFPV.

Results

Initiation of HFPV was associated with improvements in oxygenation index, oxygen saturation index, Pao₂/Fio₂, and oxygen saturation as measured by pulse oximetry/Fio₂ as early as 12 hours (P < .05), which continued through 48 hours after transition. Improved oxygenation occurred without an increase in mean airway pressures. Reductions in Paco₂ occurred 6 hours after initiation of HFPV and continued through 48 hours (P < .01). Improved gas exchange was accompanied by reduced peak-inflating pressures at all time intervals after initiation of HPFV (P < .01). Vasopressor scores were similar before and after initiation of HFPV in patients requiring vasoactive support. Twenty-six (83.9%) of 31 patients survived to hospital discharge.

Conclusions

In a heterogeneous population of pediatric ARF failing conventional ventilation, HFPV efficiently improves gas exchange in a lung-protective manner.     

Noninvasive continuous positive airway pressure delivered by helmet in hematological malignancy patients with hypoxemic acute respiratory failure

Objective To compare the efficacy of early administration of noninvasive continuous positive airway pressure (nCPAP) delivered by the helmet vs. face mask to treat hematological malignancy patients with fever, pulmonary infiltrates, and hypoxemic acute respiratory failure.Design and setting Prospective clinical study with historical matched controls in the hematology department of a university hospital.Patients and interventions Seventeen hematological malignancy patients with hypoxemic acute respiratory failure defined as: moderate to severe dyspnea, tachypnea (>30–35 breaths/min), use of accessory muscles and paradoxical abdominal motion, and PaO₂/FIO₂ ratio less than 200. Each patient was treated with nCPAP by helmet outside the ICU in the hematological ward. Arterial oxygen saturation, heart rate, respiratory rate, and blood pressure were monitored to identify early nCPAP failure. Seventeen historical-matched controls treated in the same department with face mask CPAP were selected as control population; matching criteria were age, sex, diagnosis, and PaO₂/FIO₂ ratio. Primary end-points were improvement in gas exchanges and the need for endotracheal intubation.Results Oxygenation improved in all patients after nCPAP. No patient failed helmet nCPAP because of intolerance while eigh patients in the mask group did so. nCPAP could be applied continuously for a longer period of time in the helmet group (28.44±0.20 vs. 7.5±0.45 h).Conclusions Early nCPAP with helmet improves oxygenation in selected immunosuppressed patients with hypoxemic acute respiratory failure. Tolerance of helmet nCPAP seems better than that of nCPAP delivered by mask.     

吸入沙丁胺醇对呼吸衰竭患者容积标限压力控制通气时通气参数的影响

目的　探讨在容积标限压力控制 (VTPC)通气时吸入支气管扩张剂沙丁胺醇后对机械通气参数的影响。方法　 10例平均年龄为 (6 8± 5 )岁的呼吸衰竭患者均接受气管插管与机械通气支持治疗 ;采用Newport e5 0 0型呼吸机 ,并实施定容型通气 (VCV) 30 min,潮气量 (VT)为 8～ 10 ml/ kg;测定气道阻力 (Raw)和静态顺应性 (Cst)以及通气参数的变化 ,包括气道峰压 (PIP)、平台压 (Pplat)、充气时间 (Tinflate)、吸气峰流速(PIF)、呼气峰流速 (PEF)和平均吸气流速 (VT/ Tinflate)。随后转为 VTPC通气 30 m in,并同样记录上述参数。通过同轴吸入装置吸入沙丁胺醇 6 0 0 μg后重复 VCV和 VTPC通气 ,并记录上述通气参数。结果　 10例患者的 Cst为 (38.4± 2 .7) ml/ cm H2 O,Raw为 (2 0 .1± 2 .0 ) cm H2 O· L- 1 · s- 1 。VTPC时 PIP和 VT/ Tinflate较 VCV时显著降低 (P均 <0 .0 5 ) ,PIF则显著增高 ,两种通气时的 Pplat无显著性差异 ,分别为 (2 2 .1± 0 .9) cm H2 O和(2 3.0± 1.2 ) cm H2 O(P>0 .0 5 )。吸入沙丁胺醇后患者的 Raw均显著降低 ,而 Cst无明显变化 ,VCV时的 PIP有所降低 ,但 Pplat无变化 ;VTPC时的 PIP和 Pplat与吸入前比较无明显改变 ,但 PIF和 PEF出现显著增高 ,Tinflate则相应缩短 (P均 <0 .0 5