无创正压通气在重症监护室的应用及护理

目的 分析重症监护室的危重患者在抢救治疗时,行无创正压通气的治疗情况,探讨其临床应用及护理.方法 对30例重症监护室的危重患者行无创正压通气治疗,进行针对性护理,严密观察病情变化,预防并发症的发生及护理.结果 21例无创正压通气治疗效果满意,4例面部不适,3例腹胀,2例咽干.结论 必要的通气前准备,合适的人机连接界面的选择,适当的体位与面罩的松紧度,严格的气道管理及积极观察、预防和治疗并发症是无创正压通气得以顺利进行的主要措施,可以促进患者早日康复.     

便携式呼吸机在危重患者院前院内急救转运中的应用

目的:探讨便携式呼吸机机械通气转送危重患者所需做的基础工作、可行性及注意点,以提高转运成功率.方法:对56例在院前院内抢救的危重患者应用便携式呼吸机机械通气配合镇静、止血、升压药等抢救措施,观察其转运和治疗效果.结果:48例患者在转运中病情稳定,8例患者出现病情变化经处理后好转,转送成功率100%.结论:便携式呼吸机机械通气转送危重患者可行,值得推广使用.     

无创正压通气治疗急性心源性肺水肿的疗效观察及护理

目的 探讨无创正压通气治疗急性心源性肺水肿患者的疗效及护理要点.方法 对21例常规抗心力衰竭治疗无效的急性肺水肿患者使用无创正压通气.观察无创正压通气前与通气后1h患者生命体征、氧分压、并发症发生情况和肺水肿改善情况.结果 本组21例患者除2例因病情无改善,改予经鼻纤支镜引导下气管插管机械通气,19例患者经治疗肺水肿改...     

BiPAP无创呼吸机治疗呼吸衰竭40例的护理

目的:探讨双水平无创正压通气治疗慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者的护理.方法:对40例用双水平气道内正压无创通气治疗慢性阻塞性肺疾病患者进行临床观察及全面护理,观察疗效及副作用.结果:40例患者经治疗胸闷、呼吸困难症状均改善,除5例胃胀气、2例面部充血外无其他不良反应.结论:双水平无创正压通气呼吸机配合有效的护理对慢性阻塞性肺疾病呼吸衰竭患者的治疗效果满意且副作用小.     

无创正压通气患者并发腹胀的原因

目的探讨无创正压通气(NIPPV)患者发生腹胀的原因及护理对策.方法分析57例无创正压通气患者并发腹胀的原因,采取护理措施,观察护理效果.结果 35例患者腹胀均得到不同程度缓解,促进了无创正压通气的配合,提高了治疗效果.结论无创正压通气并发腹胀与护理人员对无创正压通气技术的掌握、呼吸机参数的调节和病人的配合有关,正确实施无创正压通气技术,设置合理的呼吸机参数,并加强病人的基础护理及心理护理能缓解腹胀程度,提高无创正压通气疗效.     

机械通气在急诊抢救急性肺水肿中的应用

目的:探讨机械通气在急诊抢救急性肺水肿的临床疗效.方法:回顾性分析我院2003年1月至2009年12月我科应用机械通气辅助治疗急性肺水肿患者124例的临床资料.结果:124例中86例采用无创正压通气,38例采用有创正压通气,有创正压通气组的APACHE Ⅱ评分显著高于无创通气组(P＜0.05).所有患者机械通气2 h后呼吸困难明显缓解,心率、呼吸频率显著改善,均P＜0.01,APACHE Ⅱ评分明显改善(P＜0.05),动脉血氧分压及动脉血氧饱和度均明显升高(均P＜0.05).结论:机械通气可有效改善急性肺水肿患者的临床症状,减轻呼吸窘迫,迅速纠正低氧血症,提高抢救成功率.     

无创正压通气在慢性阻塞性肺疾病合并Ⅱ型呼吸衰竭患者中的应用与护理

目的:探讨无创正压通气在治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭患者中的疗效及护理方法.方法:观察36例COPD合并Ⅱ型呼吸衰竭患者无创正压通气治疗前后临床症状及血气分析的变化,并给予相应护理,进行总结和分析.结果:经无创正压通气治疗后,患者呼吸困难症状明显减轻,动脉血氧分压和二氧化碳分压明显改善(P<0.05);无一例发生明显呼吸机相关并发症.结论:COPD合并Ⅱ型呼吸衰竭患者应用无创正压通气操作简单,创伤小,减少了气管插管或气管切开的危险因素,降低了并发症的发生率.     

无创通气在重症心衰25例中的应用及护理

目的探讨双水平无创正压通气在重症心力衰竭患者中的应用效果及护理措施。方法选择25例重症心力衰竭患者在药物与氧疗治疗基础上,给予配合无创正压通气治疗。结果治疗2 h后血pH、血氧饱和度、呼吸频率、心率均较治疗前显著改善,好转者21例,未发生严重并发症。结论使用无创正压通气治疗重症心力衰竭的患者能显著改善预后。     

肾移植术后卡氏肺囊虫性肺炎合并急性呼吸衰竭患者应用无创正压通气治疗的监测与护理

目的 探讨肾移植术后对卡氏肺囊虫性肺炎(PCP)合并急性Ⅰ型呼吸衰竭患者应用无创正压通气的监测及护理要点. 方法 2004年1月-2008年1月收集肾移植术后PCP合并急性Ⅰ型呼吸衰竭患者20例,在行无创正压通气治疗的同时进行病原学的治疗和免疫抑制剂方案凋整、积极对症及营养支持治疗.在通气期间做好患者的心理护理、生命体征的监测、不良反应的预防及管道的护理. 结果 20例患者中16例无创正压通气治疗有效,好转出院,4例患者疗效欠佳,行气管插管有创机械通气治疗,其中1例治愈出院,3例死亡.通气治疗过程中出现面部皮肤压迫损伤2例,口鼻咽干燥4例,胃肠胀气3例,均予及时纠正,均未发生误吸. 结论 无创正压通气期间做好患者的监测是确保无创通气成功的重要环节,而正确护理是减少无创通气的并发症及提高疗效的关键.     

无创正压通气治疗急性重症心力衰竭的护理

总结应用无创正压通气治疗急性重症心力衰竭的护理经验。对 10例急性重症心力衰竭患者在危重期时使用无创呼吸机进行双水平正压通气 (BiPAP)治疗 ,针对不同患者的护理需求给予相关的护理措施。 10例患者低氧血症得到有效控制 ,心慌、气促、喘累等症状得到明显改善 ,均顺利渡过危重期。上机期间 ,并发症发生率低 ,仅见分泌物潴留 1例。对使用无创正压通气治疗的急性重症心力衰竭患者应加强护理 ,重视心理疏导 ,消除患者的恐惧感 ;最大限度降低患者的不适 ,提供舒适护理 ;保持呼吸道通畅 ,鼓励患者咳嗽咳痰 ;预防并发症的发生。     

Fiberoptic bronchoscopy during noninvasive positive pressure ventilation delivered by helmet

OBJECTIVE: To evaluate the feasibility and safety of fiberoptic bronchoscopy (FOB) with bronchoalveolar lavage (BAL) during noninvasive positive pressure ventilation (NPPV) delivered by helmet in patients with acute respiratory failure (ARF) and suspected pneumonia. DESIGN AND SETTING: Prospective, clinical investigation in a general intensive care unit (ICU) of a university hospital. PATIENTS AND PARTICIPANTS: Four adult patients with ARF who underwent NPPV via the helmet and required fiberoptic BAL for suspected pneumonia. INTERVENTIONS: NPPV was delivered through the helmet in the pressure support ventilation mode. The specific seal connector placed in the plastic ring of the helmet allowed the passage of the bronchoscope, maintaining assisted ventilation. Arterial blood gas levels, pH, oxygen saturation, respiratory rate, heart rate, and mean arterial blood pressure were monitored during the study. RESULTS: Helmet NPPV avoided gas exchanges deterioration during FOB and BAL, with good tolerance. During the procedure heart rate increased by 5% and mean arterial blood pressure by 7% over baseline; these levels returned to prebronchoscopic values immediately after the withdrawal of the bronchoscope. Endotracheal intubation was never required during the 24 h after the procedure. BAL yielded diagnostic information in three of four patients. CONCLUSIONS: NPPV through the helmet allows a safe diagnostic FOB with BAL in patients with hypoxemic ARF, avoiding gas exchange deterioration, and endotracheal intubation. Electronic supplementary material: is available if you access this article at http://dx.doi.org/10.1007/s00134-002-1554-5. On that page (frame on the left side), a link takes you directly to the supplementary materials.     

高原高寒地区长途跨海拔转运新冠肺炎患者的生物安全防护规范探讨

高海拔地区长途跨海拔转运新型冠状病毒肺炎（简称“新冠肺炎”）患者的生物安全防护和应用效果问题值得探讨。我院采用多种措施,包括：多学科联合会诊,医院临时组建转运专家组,分析讨论长途转运存在的风险、困难及应对措施,制定了详细周密的转运方案,成功完成21例新冠肺炎患者长途跨海拔转运,并达到了生物安全防护要求。新冠肺炎患者的跨海拔长途转运较为特殊,任务较为紧急,准备时间较短,流程有一定的局限性,还需要不断的完善和改进,逐步建立更为全面的跨海拔长途转运体系。     

无创呼吸机治疗急性左心功能衰竭的临床疗效

目的研究无创呼吸机治疗急性左心功能衰竭的临床价值。方法对22例经药物治疗后30 min仍无效的急性左心功能衰竭患者采用无创呼吸机通气治疗,观察患者治疗前后临床症状、体征及呼吸频率、心率、脉搏血氧饱和度(SpO2)、动脉血氧分压(PaO2)等的变化。结果经无创呼吸机治疗后有18例症状缓解,有效率达81.8%,呼吸频率(RR)、心率(HR)较治疗前明显下降(P0.01),SpO2、PaO2较治疗前明显上升(P0.01),差异均有统计学意义。结论无创呼吸机通气可作为药物治疗效果不佳的重症急性左心功能衰竭的较好治疗方法。     

无创通气在机械通气撤离中的作用

目的 探讨无创通气(Noninvasive positive pressure Ventilation,NNPV)在多种原因导致的急性呼吸衰竭机械通气患者撤机流程中的有效性.方法 前瞻性分析2007年1月至2008年12月浙江大学医学院附属邵逸犬医院ICU人选的71例急性呼吸衰竭机械通气患者.经气管插管机械通气治疗48 h后,达到临床撤机条件,但末能完成自主呼吸试验,排除NPPV禁忌证,将患者随机(随机数字法)分成无创通气序贯撤机(NPPV组,n=36)和传统撤机方法(IPPV组,n=35)两组.NPPV组拔管前予提高压力支持水平休息30 min,拔管后立即给予NPPV作为撤机方法;IPPV组传统方法撤机.观察两组患者自主呼吸试验前后呼吸力学参数、动脉血气、循环指标的变化,以及分组后两组机械通气2 h后的心肺参数,同时比较两组患者的转归.结果 分绀后机械通气2 h后心肺参数差异无统计学意义.与IPPV组相比,NPPV组机械通气时间、ICU住院时间、总住院时间明显缩短,分别为[(14.88 ±3.76)d vs.(20.68±2.79)d,P<0.01);(14.16±3.45)d vs.(2.57±7.71)d,P<0.01);IPPV组分别为(23.39±5.19)d vs.(33.89±8.58)d,P<0.01)],NPPV组并发症发生率明显低于IPPV组(22.9%vs.72.2%,P<0.01),特别是肺部感染发生率较低(6.1%vs.36.1%,P<0.01).结论 NPPV适用于多种原因导致的呼吸衰竭的撤机过程.把握无创通气NPPV的适应证,以及在撤机过程中及早进行NPPV干预,可以提高NPPV住序贯撤机中的成功率.     

经鼻高流量氧疗联合无创正压通气治疗慢性阻塞性肺疾病合并呼吸衰竭患者的效果

目的探讨经鼻高流量氧疗(HFNC)联合无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)合并呼吸衰竭患者的效果及对动脉血氧分压、动脉血二氧化碳分压与动脉血氧饱和度水平的影响。方法选取2017年1月至2019年6月山西医科大学第二医院急诊科收治的126例COPD合并呼吸衰竭的患者,男69例,女57例,年龄(58.94±5.89)岁,年龄范围为45~76岁,采用随机数表法将其随机分为NPPV组与HFNC组,每组63例。NPPV组患者给予NPPV,HFNC组在NPPV组基础上给予HFNC,比较两组患者治疗后48 h的临床治疗效果和并发症发生情况,并比较两组患者治疗前后血氧分压、血二氧化碳分压、血氧饱和度水平、心率、呼吸频率及痰液黏稠度变化。结果治疗后,HFNC组治疗有效率[95.2%(60/63)]高于NPPV组[82.6%(52/63)];HFNC组血氧分压[(87.87±9.45)mmHg,1 mmHg=0.133 kPa]及血氧饱和度水平[(89.29±8.99)%]高于NPPV组[(78.43±8.69)mmHg、(82.21±8.20)%],血二氧化碳分压水平[(47.95±4.85)mmHg]较NPPV组[(56.72±5.19)mmHg]降低;HFNC组心率[(85.45±4.38)次/分]和呼吸频率水平[(18.39±2.03)次/分]低于NPPV组[(92.87±4.72)次/分、(22.49±2.52)次/分]低于NPPV组,差异有统计学意义(P<0.05)。结论采用HFNC联合NPPV治疗COPD合并呼吸衰竭患者具有较好的临床治疗效果,能够改善血氧分压、血二氧化碳分压和血氧饱和度水平,值得在临床上推广应用。     

The evidence for noninvasive positive-pressure ventilation in the care of patients in acute respiratory failure: a systematic review of the literature

Noninvasive positive-pressure ventilation (NPPV) is increasingly being used in the care of patients suffering acute respiratory failure. High-level evidence supports the use of NPPV to treat exacerbation of chronic obstructive pulmonary disease (COPD). NPPV has also been successfully used with selected patients suffering acute hypoxemic respiratory failure and to allow earlier extubation of mechanically ventilated COPD patients. The evidence for NPPV for acute cardiogenic pulmonary edema is inconclusive. With selected patients NPPV decreases the rate of intubation, mortality, and nosocomial pneumonia. Predictors of NPPV failure include greater severity of illness, lower level of consciousness, lower pH, more air leak around the patient-mask interface, greater quantity of secretions, poor initial response to NPPV, and the presence of pneumonia. NPPV obviates intubation in > 50% of appropriately selected patients. Both nasal and oronasal interfaces have been successfully used to apply NPPV, but the oronasal interface is often preferred for acute respiratory failure. Any ventilator and ventilator mode can be used to apply NPPV, but portable pressure ventilators and pressure-support mode are most commonly used. Inhaled bronchodilators can be administered during NPPV, and NPPV can be delivered with helium-oxygen mixture. Institution-specific practice guidelines may be useful to improve NPPV success.     

无创正压通气治疗老年急性心肌梗死并左心衰竭的临床研究

目的:观察无创正压通气(NPPV)在老年急性心肌梗死合并左心衰竭患者治疗中的作用。方法:将60例符合入选标准的老年急性心肌梗死合并左心衰竭患者分为两组,治疗组30例经口鼻面罩行NPPV,通气模式采用压力支持(PSV)+呼气末正压(PEEP)模式;对照组30例给予高浓度面罩吸氧,两组均给予改善心肌缺血、利尿、扩血管、强心和镇静等治疗。结果:治疗组经NPPV2h后,患者的临床症状、动脉血气指标、心率和呼吸频率均明显改善并明显优于对照组(P<0.05),与对照组比较,治疗组病死率、气管插管率显著降低,住院时间显著缩短,差异均有显著性(均P<0.05)。结论:NPPV是抢救老年急性心肌梗死合并左心衰竭患者的有效措施。     

无创正压通气治疗急性呼吸窘迫综合征的前瞻性队列研究

目的 观察和评价无创正压通气(NPPV)对急性呼吸窘迫综合征(ARDS)的疗效和安全性.方法 采用前瞻性队列研究,分析2004年1月-2007年12月北京朝阳医院呼吸重症监护病房(RICU)使用NPPV治疗ARDS患者的临床资料.结果 ①31例患者纳入本研究,其中男23例,女8例;年龄20～76岁,平均(49±17)岁;NPPV前急性生理学与慢性健康状况评分系统Ⅰ(APACHE Ⅰ)评分(14±8)分,氧合指数(PaO2/FiO2)(123±32)mm Hg(1 mm Hg=0.133 kPa).②NPPV成功率为74.2%(23/31),非肺部感染所致ARDS的成功率显著高于肺部感染所致ARDS(100%比60%,P=0.017).③与NPPV前相比,成功组NPPV治疗后2 h及24 h的心率(HR)、呼吸频率(RR)及PaO2/FiO2均有显著改善(P均<0.01),而失败组上述指标不但无显著改善,尚伴有动脉血二氧化碳分压(PaCO2)逐渐升高(P<0.05).患者均无NPPV相关的严重并发症.结论 对于无NPPV禁忌的ARDS患者,NPPV可作为一线呼吸支持手段;但对于在短期应用NPPV后生命体征及动脉血气无显著改善者,尤其是肺部感染诱发ARDS时应及早改为有创通气.     

Effectiveness of non-invasive positive pressure ventilation differs between decompensated chronic restrictive and obstructive pulmonary disease patients

OBJECTIVE: To compare the efficiency of non-invasive positive pressure ventilation (NPPV) in decompensated patients with either chronic obstructive pulmonary disease (COPD) or chronic restrictive pulmonary disease. DESIGN: Retrospective study. SETTING: A 17-bed intensive care unit in a university teaching hospital. SETTING: Sixty-four patients with COPD (age: 70+/-13 years, sex ratio: 37 male to 27 female patients, forced expiratory volume in 1 s: 31+/-13% predicted) and 20 patients with chronic restrictive pulmonary disease (age: 75+/-9 years, sex ratio: 9 male to 11 female patients, total lung capacity: 57+/-17% predicted) consecutively treated with NPPV (facial mask, pressure support ventilation (PSV) +/- PEEP) for acute respiratory failure. MEASUREMENTS AND RESULTS: There were no statistically significant differences between COPD and patients with chronic restrictive pulmonary disease in terms of cause of exacerbation, use of oxygen therapy or NPPV at home, severity of acute respiratory failure (ARF), mean delay from intensive care admission to initiation of NPPV and total duration of NPPV. Patients with chronic restrictive pulmonary disease had a lower success rate on NPPV (without need of tracheal intubation) than COPD (35% vs 67%, p=0.01). Causes of NPPV failure were not different between COPD and patients with restrictive disease. After 12 h of NPPV, restrictive patients who succeeded with NPPV had similar respiratory rate, minute ventilation and arterial blood gas to COPD patients. At the 3rd and 12th h of NPPV, improvements in pH and PaCO(2) were predictive of NPPV success in COPD, but not in restrictive patients. CONCLUSION: The results of this retrospective study suggest that the effectiveness of NPPV for acute decompensation is less in patients with chronic restrictive pulmonary disease as compared to COPD.     

Noninvasive positive-pressure ventilation with different interfaces in patients with respiratory failure after abdominal surgery: a matched-control study

BACKGROUND: Acute respiratory failure (ARF) is a relatively common complication after abdominal surgery. METHODS: We compared the efficacy of noninvasive positive-pressure ventilation (NPPV) delivered via helmet versus via face mask in patients with ARF after abdominal surgery in 2 intensive care units (31 beds) in the hospital affiliated with the Catholic University of Rome. Twenty-five patients with ARF after abdominal surgery were treated with NPPV via helmet, and the data from those patients were matched with 25 controls chosen from a historical group of 151 patients treated with face mask during the previous 2 years for respiratory complications after abdominal surgery. The matching was done according to age, Simplified Acute Physiology Score II, and the ratio of P(aO(2)) to fraction of inspired oxygen (P(aO(2))/F(IO(2))). NPPV was delivered in pressure support, starting with 10 cm H(2)O, and positive end-expiratory pressure (PEEP) was increased in steps of 2-3 cm H(2)O, up to a maximum of 12 cm H(2)O, in order to maintain an arterial oxygen saturation over 90% with the lowest possible F(IO(2)). RESULTS: NPPV significantly improved P(aO(2))/F(IO(2)) in both groups. Five of 25 helmet patients (20%) and 12 of 25 mask patients (48%) were intubated (p < 0.036). The main cause for NPPV failure in both groups was intolerance (mask 32% vs helmet 12%, p = 0.6). Heart rate, systolic blood pressure, respiratory rate, duration of NPPV, level of pressure support, and PEEP presented no differences between the 2 groups, nor did intensive-care-unit or hospital mortality. Both the helmet and mask interfaces were effective in improving gas exchange and respiratory rate. The global rate of NPPV complications (mask intolerance, major leaks that caused ventilator malfunction, and ventilator-associated pneumonia) was significantly higher in the mask group than in the helmet group (19 patients vs 4 patients, p < 0.03). CONCLUSIONS: NPPV can be an alternative to conventional ventilation in patients with ARF after major abdominal surgery, and helmet use is associated with a better tolerance and a lower rate of complications.