双相正压通气治疗急性呼吸窘迫综合征

目的探讨双相气道正压(BIPAP)通气模式治疗急性呼吸窘迫综合征(ARDS)患者的疗效及其对血流动力学和气道力学的影响.方法随机将20例ARDS患者分为BIPAP通气模式组(BIPAP组)和间歇正压通气模式组(IPPV组),行机械通气治疗,每组各10例.观察两组血流动力学、血气分析、呼吸力学指标.结果BIPAP组机械通气时间平均为13天,显著低于IPPV组的21天(P＜0.05).BIPAP组患者安定、吗啡和万可松用量显著低于IPPV组(P＜0.05);IPPV组吸气峰压、平台压和呼气末正压均显著高于BIPAP组(P＜0.05).心率、平均动脉压、平均肺动脉压、体循环阻力和心脏指数两组差别无显著性意义(P＞0.05),但IPPV组肺血管阻力显著高于BIPAP组(P＜0.05).两组间动脉血氧分压、二氧化碳分压和pH值差别无显著性意义(P＞0.05),BIPAP组混合静脉血氧分压显著高于IPPV组(P＜0.05).结论BIPAP通气模式人机关系协同性好,能够降低肺血管阻力,增加混合静脉血氧分压,缩短了ARDS治疗的机械通气时间.     

双相压通气治疗急性呼吸窘迫综合征

目的：探讨双相气道正压（BIPAP）通气模式治疗急性呼吸窘迫综合征（ARDS）患者的疗效及其对血流动力学和气道力学的影响。方法;随机将20例ARDS患者分为BIPAP通气模式组（BIPAP组）和间歇正压通气模式组（IPPV组）,行机械通气治疗,每组各10例。观察两组血流动力学、血气分析、呼吸力学指标。结果：BIPAP组机械通气时间平均为13天,显著低于IPPV组的21天（P＜0．05）。BIPAP组患者安定、吗啡和万可松用量显著低于IPPV组（P＜0．05）;IPPV组吸气峰压、平台压和呼气末正压均显著高于BIPAP组（P＜0．05）。心率、平均动脉压、平均肺动脉压、体循环阻力和心脏指数两组差别无显著性意义（P＞0．05）,但IPPV组肺血管阻力显著高于BIPAP组（P＜0．05）。两组间动脉血氧分压、二氧化碳分压和pH值差别无显著性意义（P＞0．05）,BIPAP组混合静脉血氧分压显著高于IPPV组（P＜0．05）。结论：BIPAP通气模式人机关系协同性好,能够降低肺血管阻力,增加混合静脉血氧分压,缩短了ARDS治疗的机械通气时间。     

开胸手术时双肺两种不同通气方式可行性应用

开胸手术行健侧单肺通气,所出现的肺内分流和低氧血症,倍受人们关注.我院在开胸手术中采用健侧肺间歇正压通气(intermittent positive pressure ventilation,IPPV),患侧肺采用持续正压通气(continuous positive airway pressure,CPAP),收到满意疗效.     

不同单肺通气模式对开胸手术患者血流动力学的影响

目的 评价不同单,肺通气模式对开胸手术患者血流动力学的影响.方法 选择拟行肺叶切除术或食道癌根治术的患者45例,年龄45～64岁,采用随机数字表法,将患者随机分为3组(n=15),间歇正压通气组(IPPV组);IPPV+呼气末正压组(IPPV+PEEP组):IPPV+5 cm H2O PEEP单肺通气30 min后,再行IPPV+10 cm H2O PEEP单肺通气30 min:IPPV+持续气道正压通气组(IPPV+CPAP组)通气侧肺采用IPPV模式,术侧肺加用5 cm H2OCPAP模式1h.于麻醉诱导前、气管插管后10 min、双肺通气30 min、单肺通气30 min、1h及术毕(T1-6)时记录MAP、HR,心排血量(CO)、心指数(CI)、每搏量(SV)和每搏指数(SVI).并于 T1,2,4-6时采集动脉血样行血气分析,记录血糖(Glu)和血乳酸(Lac)水平,计算氧供(DO2)及氧供指数(DO2I).结果 与IPPV组比较,IPPV+PEEP组T4,5时SV、SVI、CO、CI、DO2,DO2I降低(P＜0.05),Glu和Lac水平差异无统计学意义,IPPV+CPAP组上述各指标比较差异无统计学意义(P＞0.05).与IPPV+ PEEP组比较,IPPV+ CPAP组T4,5时SV、SVI、CO、CI、DO2、DO2I升高(P＜0.05),Glu和Lac水平差异无统计学意义(P＞0.05).结论 开胸手术患者通气侧肺采用IPPV模式,术侧肺加用5 cm H2O CPAP模式对患者血流动力学无明显影响,而通气侧肺IPPV+ PEEP模式虽然可导致血流动力学波动,但程度较小,可维持正常的机体氧供.     

肥胖患者围手术期通气策略Meta分析

目的 系统评价围手术期不同通气策略对肥胖患者通气和肺功能的影响,选择最佳通气策略. 方法 网上检索EBSCO、PubMed、Spring、Ovid、Wiley、中国知网、维普网、万方数据等数据库,选择全身麻醉诱导期和拔管后的给氧模式以及术中不同潮气量对肥胖患者通气和肺功能影响的随机对照试验(randomized controlled trial,RCT),应用RevMan 5.3软件对纳入文献进行Meta分析. 结果 共纳入24篇RCT,946例患者.①麻醉诱导期头高位吸氧较平卧位吸氧无通气安全时限更长(P＜0.001),而自主呼吸时加用持续正压通气(continues positive airway pressure,CPAP)PaO2水平更高(P=0.005),转为机械通气后间歇正压通气(intermittent positive pressure ventilation,IPPV)+呼气末正压通气(positive end expiratory pressure,PEEP)较单用IPPV无通气安全时限更长(P＜0.001),PaO2更高(P＜0.001).②术中大潮气量比小潮气量通气联合PEEP获得更高的氧合指数(oxygenation index,OI)(P=0.02),但同时大潮气量通气可引起更高的气道压(P＜0.001).③拔管后采用无创正压通气(non-invasive positive pressure ventilation,NIPPV)较鼻导管吸氧PaO2更高(P=0.004). 结论 肥胖患者诱导期宜采用头高位CPAP以及IPPV+PEEP通气,术中采用大潮气量+高PEEP,术后拔管后采用NIPPV.     

机械通气在刨伤性连枷胸合并肺挫伤治疗中的应用

目的探讨机械通气治疗创伤性连枷胸合并肺挫伤的疗效。方法对20例创伤性连枷胸合并肺挫伤的患者行机械通气后分析血气分析等各种参数的变化。结果机械通气治疗后心率（HR）、氧分压（PaO2）、二氧化碳分压（PaCO2）、氧和指数（PaO2/FIO2）均较前明显改善。结论机械通气治疗创伤性连枷胸合并肺挫伤疗效显著。     

全麻腹腔镜胃癌根治术中应用小潮气量联合低水平呼气末正压通气对老年患者呼吸功能的影响

目的:观察全身麻醉腹腔镜胃癌根治术中应用小潮气量(tidal volume,VT)联合低水平呼气末正压通气(positive end expiratory pressure,PEEP)对老年患者呼吸功能的影响。方法:将34例ASA I或II级腹腔镜胃癌根治术老年患者分为A、B两组。A组:机械通气模式为间歇正压通气(intermittent positive pressure ventilation,IPPV)加5cm H2O PEEP,VT=6ml/kg,f=16次/min;B组:机械通气模式为IPPV,VT=9ml/kg,f=12次/min。观察术前(T1)、麻醉插管后30min(T2)、拔管后15min(T3)的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、呼气末二氧化碳分压(PETCO2)、肺泡-动脉氧分压差(A-aDO2)、平均动脉压(mean arterial pressure,MAP)、中心静脉压(central venous pressure,CVP)及术中的气道峰压(peak airway pressure,Ppeak)。结果:T3时,A组PaO2明显高于B组(P<0.05),A组A-aDO2明显低于B组(P<0.05)。其他各时点A、B两组PaO2、PaCO2、PETCO2、A-aDO2、MAP、CVP、Ppeak组间比较差异无统计学意义(P>0.05)。结论:腹腔镜胃癌根治术中应用小VT联合低水平PEEP通气能有效改善老年患者术后低氧血症,减少肺部并发症,有利于老年患者呼吸功能的恢复,对血流动力学无明显影响,是老年患者腹腔镜上腹部手术全麻安全、有效的通气方法。     

无创正压通气治疗全麻拔管后呼吸衰竭

目的 评价无创正压通气(NIPPV)治疗全身麻醉手术拔管后呼吸衰竭的疗效及影响因素.方法 全麻手术拔管后48 h内发生呼吸衰竭的患者34例,应用BiPAP Vision呼吸机实施无创正压通气治疗,比较治疗后避免再插管(成功组)和需要再插管(失败组)患者的基础状态、通气疗效及临床结果,并分析可能的影响因素.结果 无创正压通气使70.6%的术后呼吸衰竭患者避免插管.与失败组相比,成功组心肺并发症所致呼吸衰竭的比例和需要人工辅助吸痰的比例明显低(P<0.05),麻醉药残留呼吸抑制的比例高(P<0.01).结论 无创正压通气治疗全身麻醉手术后呼吸衰竭能够减少再插管率,但可能不适用于存在心肺并发症和排痰障碍的患者.     

无创正压通气的临床应用及进展

无创正压通气（noninvasive positive pressure ventilation，NPPV）是指通过鼻罩或面罩连接呼吸器和患者，无需气管插管和气管切开建立人工气道的辅助机械通气模式。NPPV保留了患者吞咽、进食、语言交流和咳嗽反应机制。     

胸骨肋骨内固定术在严重胸外伤中的临床意义

目的：探讨胸骨肋骨内固定术在严重胸外伤中的临床疗效及意义。方法回顾性研究2009年6月～2013年8月我院收治的76例创伤性连枷胸患者的临床资料,分为胸骨肋骨内固定术治疗组38例,保守治疗组38例。结果两组患者共治愈72例,死亡4例（每组各2例）,差异无统计学意义（P＞0.05）。但是手术组治疗后血气分析结果较保守组改善显著,机械通气时间、ICU停留时间、住院时间较保守治疗组明显缩短（P＜0.05）,胸廓畸形及发生呼吸道并发症（呼吸衰竭、肺部感染、血气胸、肺不张）较保守治疗组明显减少,差异有统计学意义（P＜0.05）。结论胸骨肋骨内固定术在减少ICU停留和住院天数方面有明显疗效,并可以减轻机械通气时间、呼吸道感染等并发症,是治疗连枷胸的理想方法。     

Comparison of the haemodynamic effects of intermittent positive pressure ventilation with high frequency jet ventilation

The cardiorespiratory effects of intermittent positive pressure ventilation and high frequency jet ventilation with and without positive end expiratory pressure were compared in patients following valvular heart surgery (mitral and/or aortic). Twenty patients received intermittent positive pressure ventilation and high frequency jet ventilation with 0, 0.5 and 1.0 kPa positive end expiratory pressure. High frequency jet ventilation was well tolerated. The addition of 1.0 kPa positive end expiratory pressure was associated with preservation of the arterial oxygen tension without any increase in shunt or significant adverse haemodynamic effect. The results are discussed and compared with a previous study of high frequency jet ventilation following aortocoronary bypass graft surgery.     

间歇正压通气和呼气末正压通气对犬眼内压的影响

目的 探讨间歇正压通气(IPPV)和呼气末正压通气(PEEP)对犬眼内压(10P)的影响.方法 实验犬8只,麻醉后分别监测基础条件下和各种机械通气条件下的IOP、CVP、MAP.结果 实施20 ml/kg和30 ml/kg两种不同潮气量的IPPV时IOP差异无统计学意义.实施10、15、20cm H20三种不同压力值的PEEP时IOP均显著升高(P<0.01).结论 IPPV对IOP影响不大,PEEP可使IOP显著升高.     

Persistent pneumothorax treated with continuous positive airway pressure

A patient who presented with persistent pneumothorax after blunt chest trauma is described. The lung re-expanded partially in response to chest drain suction but some areas remained collapsed. The institution of continuous positive airway pressure on an intermittent basis, was followed by complete re-expansion of the lung and resolution of the pneumothorax.     

The Downs'' adjustable flow generator

A venturi powered device for the generation of continuous positive airways pressure has been assessed. Some of its functional characteristics appear to be ideal, but the oxygen concentration and adequacy of flows require checking after each adjustment. A positive pressure relief valve and an inlet valve are necessary for the safe use of the system and an airway pressure monitor is recommended.     

Efficacy of the laryngeal tube during intermittent positive-pressure ventilation

We studied the efficacy of the laryngeal tube (VBM, Germany) during intermittent positive-pressure ventilation in 50 patients. After induction of anaesthesia and neuromuscular blockade, a size 4 laryngeal tube was inserted for patients of height 155 cm or greater. After insertion of the laryngeal tube, its pharyngeal and oesophageal balloons were inflated to an intracuff pressure of 60 cmH(2)O. An Ambu self-inflating bag was attached to the laryngeal tube and the lungs were ventilated manually at 15 breath.min(-1). It was possible to ventilate the lungs at the first attempt in 47 patients (94%). The airway pressure at which air leaked around the laryngeal tube exceeded 18 cmH(2)O in 41 patients (82%), and was > 30 cmH(2)O in 25 (50%). Median [interquartile range (range)] leak pressure was 30 [20-30 (6 to > 30)] cmH(2)O. Median [interquartile range (range)] tidal volume was 587 [533-653 (133-800)] ml or 8.8 [8.2-10.6 (1.9-12.6)] ml.kg(-1). We conclude that the laryngeal tube has a potential role in airway management during intermittent positive-pressure ventilation for anaesthesia or cardiopulmonary resuscitation.     

Nasopharyngeal airway continuous positive airway pressure: a method to wean from or avoid mechanical ventilation in adults

A simple technique using a nasopharyngeal airway and a continuous positive airway pressure circuit has proved an effective alternative to a tight fitting nasal or face mask for delivery of continuous positive airway pressure. Nasal trauma, discomfort and mouth breathing are the main disadvantages.