BIPAP呼吸机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BIPAP呼吸机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 对比观察65例COPD合并Ⅱ型呼吸衰竭患者BIPAP呼吸机治疗前后血气分析的变化和并发症发生情况.结果 经BIPAP呼吸机治疗后,患者血气分析主要指标较治疗前明显改善,差异有统计学意义(P<0.05).结论 COPD合并Ⅱ型呼吸衰竭患者应用BIPAP呼吸机,能明显改善缺氧症状,大大减少可能发生的医院感染等并发症.     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察

选取我院收治的92例慢性阻塞性肺疾病合并呼吸衰竭患者为研究对象,将其随机分为对照组与观察组。对照组采取临床常规治疗的方法,观察组患者在此基础上接受无创呼吸机治疗,统计并评价两组患者的治疗效果。结果经治疗,观察组患者的心率(HR)、呼吸频率(RR),以及血氧分压(Pa O2)等血气分析改善情况明显优于对照组;住院时间、再入院次数及并发症发生率则显著低于对照组,数据差异具有统计学意义(P0.05)。通过对慢性阻塞性肺疾病合并呼吸衰竭患者展开无创呼吸机治疗,可有效缩短住院时间,疗效显著,且不良反应少,值得临床推广应用。     

浅快呼吸指数和气道闭合压作为呼吸机撤离指标的临床研究

目的探讨浅快呼吸指数(RVR)和气道闭合压对机械通气患者撤机的指导意义.方法将准备撤机的90例患者按呼吸衰竭病因分为慢性阻塞性肺疾病(COPD)急性恶化组和急性呼吸衰竭(ARF)组.床旁监测呼吸频率(RR)、潮气量、每分钟通气量(MV)、气道阻力(Raw)、顺应性、气道闭合压、内源性呼气末正压(PEEPi);在自主呼吸试验开始3分钟和30分钟时分别测定RR、潮气量,比较常规撤机指标(RR、潮气量、MV)与RVR、气道闭合压对撤机的预测价值.结果撤机成功与失败组RVR分别为COPD急性恶化组(63±22)次*min-1*L-1与(91±20)次*min-1*L-1,P<0.05;ARF组(63±21)次*min-1*L-1与(81±21)次*min-1*L-1,P<0.05;全部患者组(63±21)次*min-1*L-1与(88±20)次*min-1*L-1,P<0.05.撤机成功与失败组的气道闭合压分别为COPD急性恶化组(0.28±0.08)kPa与(0.47±0.07)kPa,P<0.05;ARF组(0.27±0.05)kPa与(0.40±0.08)kPa,P<0.05;全部患者组(0.28±0.08)kPa与(0.45±0.08)kPa,P<0.05.以RVR≤105次*min-1*L-1为标准预测撤机成功的诊断正确率、灵敏度和特异度,3组分别为COPD急性恶化组79%、91%和40%;ARF组79%、96%和17%;全部患者组79%、93%和33%.以气道闭合压≤0.44 kPa为标准预测撤机成功的诊断正确率、灵敏度和特异度,3组分别为COPD急性恶化组82%、87%和67%;ARF组83%、96%和50%;全部患者组83%、90%和62%.以撤机后果作为因变量进行Logistic回归分析显示只有RVR与气道闭合压是回归模型中有显著性的两个指标.结论RVR与气道闭合压在预测撤机后果上优于常规撤机指标.     

BiPAP呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭90例分析

对我院2000-03～2005-05应用双水平气道正压（BiPAP）治疗的慢性阻塞性肺疾病（COPD）合并呼吸衰竭90例分析如下.     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效探讨

目的:探究分析在慢性阻塞性肺疾病合并呼吸衰竭患者中采取无创呼吸机治疗的效果。方法:从2020年1月至2021年12月本院收治的慢性阻塞性肺疾病合并呼吸衰竭患者中抽选127例作为本次研究对象,采用随机数字表法分为两组,观察组64例,接受无创呼吸机联合常规药物治疗,对照组63例,接受常规药物治疗,对比两组临床治疗效果。结果:治疗前,两组患者呼吸频率、心率、血氧分压、二氧化碳分压差异无统计学意义(P>0.05);治疗后,观察组患者呼吸频率、心率、二氧化碳分压明显低于对照组,血氧分压明显高于对照组,差异具有统计学意义(t=4.342、10.614、14.179、4.386,P<0.05)。治疗前,两组患者舒张压、收缩压、pH值等差异无统计学意义(P>0.05);治疗后,观察组患者舒张压、收缩压等血压指标明显低于对照组,pH值明显高于对照组,差异具有统计学意义(t=8.155、7.002、3.496,P<0.05)。治疗前,两组患者呼吸流量峰值(PEF)、用力肺活量(FVC)、第1秒用力呼气容积(FEV1)等肺功能指标差异无统计学意义(P>0.05);治疗后,观察组肺功能指标明显高于对照组,差异具有统计学意义(t=2.845、4.168、4.824,P<0.05)。观察组患者皮肤损伤、胃胀气、口腔干燥等并发症发生率为3.13%,对照组患者皮肤损伤、胃胀气、口腔干燥等并发症发生率为14.29%,观察组患者并发症发生率明显低于对照组,差异具有统计学意义(χ2=4.999,P<0.05)。结论:在慢性阻塞性肺疾病合并呼吸衰竭患者中采取无创呼吸机治疗可以改善患者的临床症状和呼吸功能,优化肺功能和血气指标,临床治疗效果显著。     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的疗效探析

目的:探讨无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效。方法:随机选取我院2014年4月~2016年4月收治的慢性阻塞性肺疾病合并呼吸衰竭患者60例,随机分为对照组和观察组各30例。对照组给予常规治疗,观察组给予无创呼吸机治疗。比较两组患者治疗前后血氧饱和度(SaO_2)、二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)变化及并发症发生情况。结果:治疗前两组患者SaO_2、PaCO_2及PaO_2比较无显著性差异(P>0.05);治疗后观察组SaO_2、PaCO_2及PaO_2改善情况明显优于对照组(P<0.05);观察组并发症发生率低于对照组(P<0.05)。结论:应用无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭,可有效提高患者临床疗效,降低并发症发生,具有较高的临床应用价值。     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭疗效观察

目的：观察无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床疗效。方法选取我院2010-2012年收治的80例慢性阻塞性肺疾病合并呼吸衰竭患者作为研究对象,随机分对照组和实验组各40例,对照组患者采取常规治疗,实验组在常规治疗基础上增加无创呼吸机的治疗。结果两组患者临床指标均得到改善,实验组患者的治疗效果明显优于对照组,差异具有统计学意义（P＜0.05）。结论无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的临床效果明显,可缩短治疗时间,且使用更为便捷,值得临床应用推广。     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的护理

[目的]研究慢性阻塞性肺疾病（COPD）合并呼吸衰竭病人无创呼吸机治疗条件下的护理效果。[方法]将78例COPD合并呼吸衰竭并行无创呼吸机治疗的病人随机分为研究组和对照组。两组病人均进行常规的内科护理及治疗,研究组病人在此基础上加强呼吸机相关护理。[结果]研究组病人并发症发生率、不良情绪发生率明显低于对照组,治疗积极配合率明显高于对照组;研究组治疗48h后pH、PaOz明显高于对照组,PaCO2明显低于时照组,经比较差异均有统计学意义（P均〈0．05）。[结论]无创呼吸机相关护理可提高病人的治疗效果、降低并发症发生率。     

无创呼吸机治疗慢性阻塞性肺疾病合并重症呼吸衰竭的临床研究

探讨无创呼吸机治疗慢性阻塞性肺疾病(COPD)合并重症呼吸衰竭的临床疗效。选取收治的慢性阻塞性肺疾病合并重症呼吸衰竭患者78例,采取随机对照原则分为试验组和对照组各39例,试验组给予无创呼吸机治疗,对照组给予常规方式治疗,观察两组疗效的差异。治疗前,两组HR、PaCO_2、PaO2及SaO_2等指标水平相近,无明显差异(P0.05);治疗后,两组HR、PaCO_2水平下降,PaO_2及SaO_2水平上升,且试验组变化幅度大于对照组,差异存在统计学意义(P0.05);试验组住院时间,再次住院次数、住院费用及不良反应发生率均小于对照组,差异存在统计学意义(P0.05)。无创呼吸机治疗慢性阻塞性肺疾病合并重症呼吸衰竭疗效较好,能明显改善血气分析指标,降低住院时间,避免不良反应的发生,值得推广应用。     

无创呼吸机治疗慢性阻塞性肺疾病合并呼吸衰竭的效果

目的 探讨慢性阻塞性肺疾病合并呼吸衰竭患者接受无创呼吸机治疗的临床效果.方法 选取鹤壁市人民医院2019年1月至2019年12月收治的120例慢性阻塞性肺疾病合并呼吸衰竭患者为研究对象.采用随机数字表法分为对照组与观察组,每组60例.对照组接受常规治疗,观察组接受无创呼吸机治疗.比较患者血氧分压(PaO2)、二氧化碳分...     

Use of the oxygen cost of breathing as an index of weaning ability from mechanical ventilation

The oxygen cost of breathing (which is the difference in oxygen consumption measured during controlled ventilation and again during spontaneous ventilation) was measured in 30 patients between the ages of 17 and 96 years at the time of commencement of weaning from mechanical ventilation. There was a significant exponential correlation between the oxygen cost of breathing in ml/m²/min and the oxygen cost of breathing as a percentage of total oxygen consumption during spontaneous ventilation and the duration of weaning in days.     

Propofol infusion is associated with a higher rapid shallow breathing index in patients preparing to wean from mechanical ventilation.

OBJECTIVE: To determine whether propofol affects spontaneous breathing patterns in critically ill patients recovering from respiratory failure during initial attempts at liberation from mechanical ventilation. DESIGN: Observational cohort study. PATIENTS: Ten critically ill patients in the medical intensive care unit of a 300-bed community teaching hospital. MEASUREMENTS: Demographic and physiologic variables, including respiratory frequency and minute volume, were recorded while patients breathed on continuous positive airway pressure (of 5 cm H(2)O) during and 20-30 min after cessation of propofol infusion. The ratio of respiratory frequency to tidal volume (rapid shallow breathing index or RSBI) was computed for both sets of measurements and values measured during and after propofol infusion were compared. RESULTS: The mean (+/- SEM) age was 54.0 +/- 5.2 years and the mean (+/- SEM) APACHE II (Acute Physiology and Chronic Health Evaluation) score was 18.4 +/- 2.0. During propofol infusion, patients breathed with a significantly lower tidal volume (0.245 vs 0.342 L, p = 0.006), higher RSBI (155.6 vs 114.8 breaths/min/L, p = 0.004), and tended to breathe more rapidly (34.3 vs 31.7 breaths/min, p = 0.18) than at 20-30 min after stopping propofol infusion. Three of 10 patients had RSBIs that were unfavorable (> 105 breaths/min/L) for weaning while on propofol but that became favorable (< 105 breaths/min/L) 20-30 min following cessation of propofol. The weight-adjusted dose of propofol was not correlated with the changes in any of the variables. CONCLUSIONS: Propofol causes changes in breathing pattern that could lead a caregiver to erroneously conclude that a patient is not ready to begin spontaneous breathing trials. Since this effect has also been noted following benzodiazepine infusion, the clinician should consider the patient's "sedation history" when using RSBI to guide weaning decisions.     

Right ventricular function in COPD patients during weaning from mechanical ventilation

We studied the right ventricular function during a successful weaning period in 7 COPD patients without LV disease who had been mechanically ventilated for several days after an acute exacerbation of their disease. A Swan-Ganz ejection fraction thermodilution catheter performed measurements of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) before and fifteen minutes after disconnection from the ventilator at the maintenance FiO₂. Although pulmonary artery pressure (PAP) rose from 25±4 to 28.5±4.5 mmHg after disconnection from the ventilator, RVEF (0.36±0.56 to 0.35±0.12) and RVEDVI (117±51 to 126±52 ml/m²) remained similar in both conditions. We concluded that right ventricular systolic function assessed with modified pulmonary artery catheter was maintained during the weaning phase in such weanable patients. This method could easily detect any fall of RVEF or diastolic RV enlargement able to impair the weaning in some patients.     

Right ventricular function in COPD patients during weaning from mechanical ventilation

We studied the right ventricular function during a successful weaning period in 7 COPD patients without LV disease who had been mechanically ventilated for several days after an acute exacerbation of their disease. A Swan-Ganz ejection fraction thermodilution catheter performed measurements of right ventricular ejection fraction (RVEF) and right ventricular end-diastolic volume index (RVEDVI) before and fifteen minutes after disconnection from the ventilator at the maintenance FiO₂. Although pulmonary artery pressure (PAP) rose from 25±4 to 28.5±4.5 mmHg after disconnection from the ventilator, RVEF (0.36±0.56 to 0.35±0.12) and RVEDVI (117±51 to 126±52 ml/m²) remained similar in both conditions. We concluded that right ventricular systolic function assessed with modified pulmonary artery catheter was maintained during the weaning phase in such weanable patients. This method could easily detect any fall of RVEF or diastolic RV enlargement able to impair the weaning in some patients.     

浅快呼吸指数相关指标预测脱机结局的价值分析

目的 比较浅快呼吸指数(RSBI)、膈肌浅快呼吸指数(D-RSBI)和膈肌增厚浅快呼吸指数(DT-RSBI)对脱机结局的预测价值.方法 选择行机械通气治疗≥48 h且准备脱机的患者作为研究对象,在自主呼吸实验(SBT)结束或失败时测量膈肌增厚率(DTF)、膈肌位移(DE),同时记录呼吸频率和潮气量,用DE、DTF分别替...     

Application of heart-rate variability in patients undergoing weaning from mechanical ventilation

Introduction

The process of weaning may impose cardiopulmonary stress on ventilated patients. Heart-rate variability (HRV), a noninvasive tool to characterize autonomic function and cardiorespiratory interaction, may be a promising modality to assess patient capability during the weaning process. We aimed to evaluate the association between HRV change and weaning outcomes in critically ill patients.

Methods

This study included 101 consecutive patients recovering from acute respiratory failure. Frequency-domain analysis, including very low frequency, low frequency, high frequency, and total power of HRV was assessed during a 1-hour spontaneous breathing trial (SBT) through a T-piece and after extubation after successful SBT.

Results

Of 101 patients, 24 (24%) had SBT failure, and HRV analysis in these patients showed a significant decrease in total power (P = 0.003); 77 patients passed SBT and were extubated, but 13 (17%) of them required reintubation within 72 hours. In successfully extubated patients, very low frequency and total power from SBT to postextubation significantly increased (P = 0.003 and P = 0.004, respectively). Instead, patients with extubation failure were unable to increase HRV after extubation.

Conclusions

HRV responses differ between patients with different weaning outcomes. Measuring HRV change during the weaning process may help clinicians to predict weaning results and, in the end, to improve patient care and outcome.     

Maximum inspiratory pressure and rapid shallow breathing index as predictors of successful ventilator weaning

[Purpose] To investigate the predictive value of maximum inspiratory pressure (MIP) and the rapid shallow breathing index (RSBI) in a ventilator weaning protocol and to evaluate the differences between clinical and surgical patients in the intensive care unit. [Subjects and Methods] Patients aged ≥15 years who underwent orotracheal intubation for mechanical ventilation and who met the criteria of the weaning protocol were included in the study. Receiver operating characteristic (ROC) curves were calculated for the analysis of each index. [Results] Logistic regression analysis was also performed. MIP showed greater sensitivity and specificity [area under the curve (AUC): 0.95 vs. 0.89] and likelihood ratios (LR) (positive(+): 20.85 vs. 9.45; negative(−): 0.07 vs. 0.17) than RSBI in the overall sample (OS) as well as in clinical patients (CP) (AUC: 0.99 vs. 0.90; LR+: 24.66 vs. 7.22; LR-: 0.01 vs. 0.15) and surgical patients (SP) (AUC: 0.99 vs. 0.87; LR+: 9.33 vs. 5.86; LR−: 0.07 vs. 0.14). The logistic regression analysis revealed that both parameters were significantly associated with the weaning success. The MIP showed greater accuracy than the RSBI (OS: 0.93 vs. 0.85; CP: 0.98 vs. 0.87; SP: 0.93 vs. 0.87). [Conclusion] Both parameters are good predictors of successful ventilator weaning.Key words: Mechanical ventilation, Ventilator weaning, Physiological predictor indices