双水平正压通气和持续气道正压通气治疗呼吸窘迫综合征早产儿的临床疗效比较

目的 比较双水平正压通气和持续气道正压通气治疗赣州地区呼吸窘迫综合征(RDS)早产儿的临床疗效.方法 选取2017年5月至2020年4月该院收治的RDS早产儿60例为研究对象,按照随机数字表法随机分为观察组(双水平正压通气)和对照组(持续气道正压通气),各30例.对比两种治疗方式下患儿血气分析指标、并发症发生率,以及无创正压总通气时间、住院时间、有创呼吸机上机率、后期停氧时间.结果 治疗前两组患儿二氧化碳分压(PaCO2)、氧分压(PaO2)差异无统计学意义(P>0.05),治疗后观察组患儿PaCO2、PaO2优于对照组,差异有统计学意义(P<0.05).观察组患儿并发症发生率(3.33％)低于对照组(16.67％),差异有统计学意义(P<0.05).观察组无创正压总通气时间、住院时间及后期停氧时间与对照组相比,差异无统计学意义(P>0.05);观察组有创呼吸机上机率低于对照组,差异有统计学意义(P<0.05).结论 双水平正压通气可有效改善RDS早产儿血气分析指标,降低有创呼吸机上机率及并发症发生率,同时并未延长患儿住院时间、后期停氧时间以及无创正压通气时间,有一定的应用价值.     

双向气道正压通气与压力支持通气模式在成人呼吸窘迫综合征病人中的应用

双向气道正压通气与压力支持 (ＢＩＰＡＰ -ＰＳＶ)通气模式已被我院广泛应用于治疗成人呼吸窘迫综合征 (ＡＲＤＳ)及呼吸衰竭病人 ,而全麻术后合并ＡＲＤＳ的病人又有其特殊的临床特点 ,选择适当的呼吸模式进行机械通气对改善缺氧、减少机械通气引起的肺损伤、有效地控制ＡＲＤＳ的病程进展及多脏器功能衰竭的发生有着重要的意义。1　临床资料与方法　　 2 0 0 0年 1月— 2 0 0 0年 12月我院ＩＣＵ收治 18例全麻术后合并ＡＲＤＳ病人 ,男 7例 ,女 11例 ;年龄最大 80岁 ,最小 40岁 ,平均6 7岁。其中喉癌全喉切除术后 1例 ,肝癌术后 4例 ,胆…     

绵羊急性呼吸窘迫综合征开放肺压力安全性的实验研究

目的观察在绵羊急性呼吸窘迫综合征（ARDS）模型上利用控制性肺膨胀法（SI）实施肺复张策略对血流动力学及肺组织结构的影响，以期找到实施SI的理想压力及时间范围。方法14只绵羊在全麻下行纤维支气管镜温生理盐水肺泡灌洗建立ARDS模型，低流速法描记准静态压力-容积（P—V）曲线，寻找P—V曲线的上拐点（UIP）以及下拐点（LIP）。以UIP下5cm H2O（1cm H2O=0．098kPa）、UIP、UIP上10cm H2O和UIP上20cm H2O将14只绵羊随机分为4组（U-5、U＋0、U＋10、U＋20组），并作为SI的峰压进行肺复张，持续时间为60s，记录每次复张过程中及复张后连续血流动力学参数和氧合指数变化，维持至2h后实验结束，行CT、肺组织病理学检查。结果U＋20组在SI过程中出现气胸，导致绵羊死亡；其余各组肺复张过程中，对血流动力学均有明显影响。U＋10组肺复张10s即出现中心静脉压（CVP）升高，心排血量（CO）、心脏指数（CI）、平均血压（MBP）明显下降，复张后CI恢复缓慢；U＋0组及U-5组可完成整个肺复张过程，CVP轻度升高，CO、CI下降，U-5组在复张结束后15s、U＋0组在复张结束后30s恢复至复张前水平。肺组织病理学观察仍见U＋0组有肺大泡形成。结论对ARDS实施肺复张，应充分考虑压力对血流动力学及肺组织的损害；肺复张压力应选择在UIP或UIP下5cm H2O，此时对血流动力学没有明显影响。     

双相正压通气对急性肺损伤猪肺复张/开放的影响

目的 探讨气道压力释放.双相气道正压通气(APRV-BIPAP)模式下,逐步递增压力组合水平肺复张/开放策略(lung recruitment/open maneuvers,RMs)的疗效,摸索最佳压力组合,观察对血流动力学等影响.方法 经腹腔注射大肠杆菌制作猪急性肺损伤(acute lung iniuw,All)模型,APRV-BI-PAP下,逐步递增压力组合(Phigh/Plow),即RM1(30/15)、RM2(35/20)、RM3(48/25)、RM4(45/30)、RM5(50/35)、RM6(55/40)、RM7(60/45)cmH2O实施RMs,监测氧合指数(PaO2/FiO2)、血流动力学指标、平均气道压(Pmean)变化,吸气相CT扫描,评价RMs疗效.RMs完成后,处死取肺组织行病理学检查.所有资料应用SPSS 11.5统计软件包对数据进行统计学分析,采用自身前后对照,各种测定值以均数±标准差(x±s)表示,多组间采用随机区组方差分析,PaO2/FiO2与肺组织萎陷程度相关性比较采用Pearson相关分析,P<0.05为差异具有统计学意义.结果 健康幼猪8头,成模后CT扫描均显示不同程度肺泡萎陷.随 RMs,PaO2/FiO2改善,肺泡萎陷减少,以RM2后改善最明显(P<0.05),但非病变区域有肺泡过度膨胀;随压力递增,心率(HR)增快(P<0.05),平均动脉压(MAP)下降(P<0.05),PIP、Pmean和中心静脉压(CVP)升高(P<0.05),但RMs完成后能恢复到RMs前水平(P>0.05);研究过程中未发生气胸、纵隔气肿等,但病理检查有肺泡过度膨胀和间隔断裂.结论 借助APRV-BIPAP模式逐步递增压力组合实施RMs,35/20 cmH2O是最佳压力组合,对血流动力学和气道压等影响小;一旦RMs获得疗效满意,设置30/15 cmH2O维持20 min,RMs疗效好.     

气道压力释放通气在急性呼吸窘迫综合征中的应用

在小潮气量肺保护性通气时代,急性呼吸窘迫综合征(acute respiratory distress syndrome, ARDS)患者的病死率仍高,机械通气参数设置不当会进一步增加呼吸机相关性肺损伤风险。由于ARDS患者肺泡的黏弹性,气道压力释放通气(airway pressure release ventilation, APRV)长时间的吸气、较高的压力以及短暂的释放可能更适合ARDS肺泡病理生理学变化。APRV有肺复张、稳定肺泡结构等优势,已经显示出作为一种肺保护通气策略的巨大潜力,本文将对APRV相关研究进展进行综述。     

双水平气道正压通气对急性呼吸窘迫征患者的疗效

目的:分析持续正压通气与双水平气道正压通气对急性呼吸窘迫综合征患者机械通气时间、血气指标及血管内皮功能的影响.方法:将2019年5月～2020年6月收治的85例急性呼吸窘迫综合征患者,按照机械通气模式分为对照组42例和研究组43例.对照组行持续正压通气机械通气模式,研究组行双水平气道正压通气机械通气模式,对比两组临床疗...     

气道压力释放通气治疗重度急性呼吸窘迫综合征患者的监测与护理

总结14例气道压力释放通气模式治疗重度急性呼吸窘迫综合征患者的监测与护理.正确评估患者,动态调整气道压力释放通气模式的参数,监测患者自主呼吸、潮气量、通气和氧合功能及血流动力学变化,加强呼吸机管路及人工气道密闭性、镇痛镇静和人工气道的护理及气道压力释放通气模式下撤机管理.经过严密监测与护理,14例患者均成功撤机.     

早期应用持续气道正压通气治疗新生儿呼吸窘迫综合征临床观察

目的观察早期应用气管插管一肺表面活性物质注入一快速拔管后给予经鼻持续气道正压通气（intubationsurfactantextubation,INSURE）技术治疗新生儿呼吸窘迫综合征（neonatalrespiratorydistresssyndrome,NRDS）的疗效。方法NRDS患儿52例依据治疗方法不同分为2组,观察组28例均早期应用INSURE技术,对照组24例给予经鼻持续气道正压通气（nasalcontinuouspositiveairwaypressure,nCPAP）治疗。比较2组治疗前及治疗后6、24h时pa（02）、pa（C02）、pa（O2）／吸氧浓度（fractionofinspiration02,Fi02）,及nCPAP使用时间与治疗成功率。结果2组治疗6、24h后pa（02）、pa（O2）／FiO2均较治疗前增高（P〈0．05）,观察组pa（CO2）较治疗前降低（P〈0．05）,对照组pa（CO2）与治疗前比较差异无统计学意义（P〉0．05）;2组治疗后24hpa（0z）、pa（O2）／FiO2及pa（CO2）比较差异有统计学意义（P〈0．05）;观察组nCPAP使用时间较对照组短、治疗成功率较对照组高（P〈0．05）。结论早期应用INSURE技术治疗NRDS可改善患儿通气状况及氧合,缩短ncPAP使用时间,提高治疗成功率。。     

肺表面活性物质联合经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征的护理

总结肺表面活性物质联合NCPAP治疗新生儿呼吸窘迫综合征的护理体会。做好呼吸监护,保持呼吸道通畅;根据患儿体重合理选择肺表面活性物质的药物剂量,用药时做好配合,用药后密切观察病情;正确使用NCPAP,维持有效压力;同时加强NCPAP并发症的观察与护理。本组18例病情好转,肺泡萎陷得到改善,生命体征稳定后治愈出院,1例放弃治疗自动出院。     

经鼻持续气道正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征

目的 探讨经鼻持续气道正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的效果.方法 <32周的早产儿合并新生儿呼吸窘迫综合征早产儿33例随机分入2组进行对照研究:应用肺表面活性物质后立即拔管继以经鼻持续气道正压通气(S-N组)16例和应用肺表面活性物质后接受机械通气治疗(S-M组)17例.比较2组主要终点和次要终点是否需要机械通气及通气时间,以及其他相关临床特征.结果 生后7 d时,S-N组有1例(6.25%)接受机械通气,S-M组有8例(47.00%)仍不能脱离呼吸机.S-M组与S-N组相比较,用氧时间[(11.4±4.6)d与(7.0±1.9)d]、经鼻持续气道正压通气时间[(6.5±2.9)d与(3.5±2.3)d)]、机械通气时间[(5.9±3.3)d与(2.2±1.2)d]、重症监护室住院时间[(29.9±8.0)d与(21.7±10.1)d]、再次使用肺表面活性物质的概率[(12.5%,2/16)与(53.0%,9/17)],S-M组均显著高于S-N组,差异有统计学意义(P均<0.05).结论 应用肺表面活性物质后立即继以经鼻持续气道正压通气有利于新生儿呼吸窘迫综合征的治疗.     

Clinical review: Biphasic positive airway pressure and airway pressure release ventilation

This review focuses on mechanical ventilation strategies that allow unsupported spontaneous breathing activity in any phase of the ventilatory cycle. By allowing patients with the acute respiratory distress syndrome to breathe spontaneously, one can expect improvements in gas exchange and systemic blood flow, based on findings from both experimental and clinical trials. In addition, by increasing end-expiratory lung volume, as occurs when using biphasic positive airway pressure or airway pressure release ventilation, recruitment of collapsed or consolidated lung is likely to occur, especially in juxtadiaphragmatic lung legions. Traditional approaches to mechanical ventilatory support of patients with acute respiratory distress syndrome require adaptation of the patient to the mechanical ventilator using heavy sedation and even muscle relaxation. Recent investigations have questioned the utility of sedation, muscle paralysis and mechanical control of ventilation. Furthermore, evidence exists that lowering sedation levels will decrease the duration of mechanical ventilatory support, length of stay in the intensive care unit, and overall costs of hospitalization. Based on currently available data, we suggest considering the use of techniques of mechanical ventilatory support that maintain, rather than suppress, spontaneous ventilatory effort, especially in patients with severe pulmonary dysfunction.     

Effects of pressure support ventilation and continuous positive airway pressure on diaphragm performance

Many patients who are on mechanical ventilation are on ventilator modes called pressure support ventilation (PSV) and continuous positive airway pressure (CPAP) particularly when they are being weaned. As the diaphragm is responsible for approximately 75% of breathing, it is important to promote diaphragm shortening to optimize weaning from mechanical ventilation. The purpose of our 1998 quasi-experimental study was to explore the effects of PSV and CPVP on diaphragm shortening. An animal model was utilized using four Sprague-Dawley rats from the same litter purchased from Sasco (Kansas City, USA). Also measured in this study were intrathoracic pressure (DeltaITP), positive inspiratory pressure, respiratory rate, tidal volume, end-tidal carbon dioxide, central venous pressure (CVP) and mean arterial pressure (MAP). Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague-Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end-tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed. These results support that higher levels CPAP may hinder diaphragmatic function thus prolong mechanical ventilation. The purpose of this pilot study was to explore the effects of PSV and CPAP on diaphragm shortening. Also measured were DeltaITP, positive inspiratory pressure, respiratory rate, tidal volume, end-tidal carbon dioxide, CVP and MAP. Pressure support was increased in increments of 5 cm H2O at CPAP levels of 0, 2 and 4 cm H2O. A direct assessment of diaphragm shortening was achieved through the adherence of a miniaturized ultrasonic sensor to the inferior surface of the middle costal surface of the right hemidiaphragm of four Sprague-Dawley rats. Limitations of this study included a small sample size, anaesthetized rats and abdominal dissection for insertion of the ultrasonic sensor. As PSV was increased, there was a decrease in MAP, CVP, respiratory rate and end-tidal CO2. When increasing levels of CPAP were added to PSV, a decrease in diaphragm shortening was observed.     

持续气道正压-比例压力支持-自动管道补偿与双水平气道正压-压力支持通气两种模式撤机方法的比较

目的 :比较持续气道正压比例压力支持自动管道补偿 (CPAP PPS ATC)与双水平气道正压压力支持通气 (BIPAP PSV)两种模式撤机方法的结果。方法 :CPAP PPS ATC组 42例 ,BIPAP PSV组 40例 ,采用对照研究方法 ,比较两种通气模式、起始参数的调节、解决通气机依赖特点及撤机成功率。结果 :两种模式的撤机成功率无明显差异 (P>0 .0 5 ) ,两种模式均无人机对抗 ,CPAP PPS ATC模式较 BIPAP PSV模式对通气机依赖患者有更大的自主性 ,更容易实现撤机。结论 :BIPAP PSV为压力控制与自主呼吸相结合模式 ,CPAP PPS ATC为自主模式 ,CPAP PPS ATC是一种更好的机械通气撤机模式     

A comparative study of the cardiorespiratory effects of continuous positive airway pressure breathing and continuous positive pressure ventilation in acute respiratory failure

Positive end expiratory pressure (PEEP) produces cardiopulmonary effects whether administered by controlled positive pressure ventilation (CPPV) or continuous positive airway pressure (CPAP). In eight patients with acute respiratory failure, the effects of 20 cm PEEP administered via CPPV and CPAP were compared. An esophageal balloon was used to calculate the transmural vascular pressures. The control values under mechanical ventilation with no PEEP (IPPV) for PaO₂ and QS/QT (FiO₂ being 1.0) were respectively 132±15 mmHg and 31±3%; CPPV gave a PaO₂ of 369±27 mmHg and QS/QT fo 14±1.6%, CPAP 365±18 mmHg and 18±1.3% respectively. The two different modes of ventilation (CPPV and CPAP) gave identical blood gas improvement through the same level of end expiratory transpulmonary pressure despite marked differences between absolute mean airway and esophageal pressures. Conversely, hemodynamic tolerance was very different from one technique to the other: CPPV depressed cardiac index from 3.4±0.3 to 2.4±0.2 l/min/m² as well as decreasing transmural filling pressures, suggesting a reduction in venous return. Conversely, filling pressures maintained at control values during CPAP and cardiac indexes were unchanged.Abbreviations IPPV intermittent positive pressure ventilation; mechanical ventilation (controlled mode) with zero end expiratory pressure (ZEEP) - CPPV continuous positive pressure ventilation: mechanical ventilation (controlled mode) with a positive pressure during expiration - CPAP continuous positive airway pressure; spontaneous ventilation with a positive pressure maintained during expiration - PEEP positive end expiratory pressure, whatever the ventilatory mode; spontaneous (CPAP) or mechanical (CPPV) Presented in part at the 44 th annual meeting of American College of Chest Physicians, Washington DC, October 1978     

鼻塞式持续气道正压通气治疗新生儿呼吸衰竭的临床研究进展

介绍了鼻塞式持续气道正压通气治疗新生儿呼吸衰竭的临床研究进展 ,重点阐述了鼻塞式持续气道正压通气的优点、使用时间、工作原理、分类、治疗效果、临床应用、护理及局限性     

Noninvasive positive pressure ventilation in infants with upper airway obstruction: comparison of continuous and bilevel positive pressure

Objective This study evaluated the efficacy of noninvasive continuous positive pressure (CPAP) ventilation in infants with severe upper airway obstruction and compared CPAP to bilevel positive airway pressure (BIPAP) ventilation.Design and setting Prospective, randomized, controlled study in the pulmonary pediatric department of a university hospital.Patients Ten infants (median age 9.5 months, range 3—18) with laryngomalacia (n=5), tracheomalacia (n=3), tracheal hypoplasia (n=1), and Pierre Robin syndrome (n=1)Interventions Breathing pattern and respiratory effort were measured by esophageal and transdiaphragmatic pressure monitoring during spontaneous breathing, with or without CPAP and BIPAP ventilation.Measurements and results Median respiratory rate decreased from 45 breaths/min (range 24–84) during spontaneous breathing to 29 (range 18–60) during CPAP ventilation. All indices of respiratory effort decreased significantly during CPAP ventilation compared to unassisted spontaneous breathing (median, range): esophageal pressure swing from 28 to 10 cmH₂O (13–76 to 7–28), esophageal pressure time product from 695 to 143 cmH₂O/s per minute (264–1417 to 98–469), diaphragmatic pressure time product from 845 to 195 cmH₂O/s per minute (264–1417 to 159–1183) During BIPAP ventilation a similar decrease in respiratory effort was observed but with patient-ventilator asynchrony in all patients.Conclusions This short-term study shows that noninvasive CPAP and BIPAP ventilation are associated with a significant and comparable decrease in respiratory effort in infants with upper airway obstruction. However, BIPAP ventilation was associated with patient-ventilator asynchrony.     

双相气道正压通气在ICU中的应用

目的：探讨ＩＣＵ采用双相气道正压（ＢＩＰＡＰ）压力支持通气治疗多种心肺疾病的适应证范围、监测指标的选择和评价治疗作用。方法：对采用ＢＩＰＡＰ压力支持通气的３３例患者进行心率、血氧饱和度（ＳａＯ２）、平均血压（ＭＢＰ）、呼气末二氧化碳分压（ＰｅｔＣＯ２）、呼吸频率和节律及血气分析等指标的监测。结果：慢性阻塞性肺病（ＣＯＰＤ）并呼吸衰竭患者治疗２～４小时后ＰａＯ２和ＳａＯ２明显提高，通气前后比较Ｐ＜０．０５；ＰａＣＯ２和ＰｅｔＣＯ２亦有降低，但无显著性差异；能有效地改善支气管哮喘及阻塞性睡眠呼吸暂停综合征（ＯＳＡＳ）的通气状态；减慢急性肺水肿患者的心率，促进心功能的恢复；对于各种病因的低氧血症，治疗２～４小时后均得以纠正。结论：ＢＩＰＡＰ压力支持通气基本不影响血压，对心率和呼吸频率无负性影响，不增加循环系统负担，无明显并发症。     

单肺通气时持续气道正压对动脉氧合的影响

目的 利用自制的气道正压装置,对单肺通气下开胸病人的无通气肺施加志气道正压,观察无通气肺接受不同水平的持续气道正压时对动脉氧合的影响。方法 １９例需在单肺通气下开胸手术的病人（ＡＳＡ：１－２级）,随机分成２组,组１（ｎ＝１０）,对无通气肺施加０．２９４ｋＰａ（３ｃｍＨ２Ｏ）的气道持续正压（ＣＰＡＰ－３）,组２（ｎ＝９）;对无 敢肺施加０．４９０ｋＰａ（５ｃｈｍＨ２Ｏ）的气道持续正压（ＣＰＡＰ－５）     

Continuous positive airway pressure (CPAP) vs. intermittent mandatory pressure release ventilation (IMPRV) in patients with acute respiratory failure

Intermittent Mandatory Pressure Release Ventilation (IMPRV) is a positive pressure spontaneous breathing ventilatory mode in which airway pressure is released intermittently and synchronously with patient's spontaneous expiration in order to provide ventilatory assistance. Eight critically ill patients free of any factor known to alter chest wall mechanics (group 1) and 8 critically ill patients whose spontaneous respiratory activity was markedly altered by a flail chest, or by a C₅ quadraplegia and/or by the administration of opioids (group 2) were studied prospectively. CPAP and IMPRV were administered to each patient in a random order during a 1 h period using a CESAR ventilator. Gas flow, tidal volume, tracheal pressure, esophageal pressure, end-expiratory lung volume and hemodynamic parameters were measured. In group 1 patients, the ventilatory assistance provided by IMPRV was associated with a significant decrease in spontaneous tidal volume whereas all other respiratory parameters remained unchanged. In group 2 patients, IMPRV increased minute ventilation from 8.0±2.61/min to 12.2±1.81/min (p<0.05), decreased PaCO₂ from 46±7.3 mmHg to 38±6.8 mmHg (p<0.05) and reduced respiratory frequency from 21±10 bpm to 14±5.7 bpm (p<0.07). These results show that IMPRV provides significant ventilatory assistance to patients with mild acute respiratory failure either by decreasing patient's contribution to minute ventilation or by increasing alveolar ventilation in presence of respiratory depression of central or peripheral origin.Presented in part at the 32th Congrès National d'Anesthésie-Réanimation, Paris, September, 24, 1990 and at the Annual Meeting of the American Society of Anesthesiologists, Las Vegas, Nevada, October 22, 1990