BiPAP呼吸机在COPD并严重呼吸衰竭中的应用

目的 观察双水平无创正压通气（BiPAP）对慢性阻塞性肺疾病（COPD）合并严重型呼吸衰竭患者的临床疗效。方法 COPD急性加重并发严重型呼吸衰竭的患者42例分为两组，常规治疗组21例，给予氧疗、药物等常规治疗．BiPAP组21例，给予常规治疗的同时加用BiPAP无创通气。结果 治疗组及对照组均有效，但治疗组住院时间明显缩短（JP〈0．05）；BiPAP治疗后1小时即有效，一般情况下，3天后各项指标趋干正常。结论 在依从性较好的情况下，应用BiPAP治疗有较显著的临床疗效，可减少住院天数。     

BiPAP呼吸机治疗脂肪栓塞综合征并急性呼吸衰竭2例

我院2005年经面罩BiPAP救治2例脂肪栓塞综合征（FES）并急性呼吸衰竭，效果满意，现报告如下。     

BiPAP ViSION 在慢性阻塞性肺疾病Ⅱ型呼吸衰竭的应用和护理

目的 探讨经鼻(面)罩双水平气道内正压通气(BiPAP)ViSION型呼吸机对慢性阻塞性肺疾病(COPD)伴Ⅱ型呼吸衰竭患者疗效及护理特点。方法 应用BiPAP ViSION型呼吸机对21例COPD伴Ⅱ型呼吸衰竭患者采用鼻/面罩连接单向呼气活瓣行双水平气道正压通气,观察其通气前后动脉血气及临床表现变化。结果 通气治疗后19例患者动脉血氧分压(PaO_2)及氧饱和度(SaO_2)明显升高(P<0.01),二氧化碳分压(PaCO_2)显著降低(P<0.05);肺性脑病症状消失,昏迷患者神志转清。2例病情恶化,其中1例改用有创通气后好转,1例拒绝有创通气死亡。结论BiPAP ViSION呼吸机治疗COPD伴Ⅱ型呼吸衰竭的疗效较为肯定,正确的护理对提高其疗效和减少并发症至关重要。     

Glibenclamide treatment in a Cantú syndrome patient with a pathogenic ABCC9 gain‐of‐function variant: Initial experience

Cantú syndrome (CS), characterized by hypertrichosis, distinctive facial features, and complex cardiovascular abnormalities, is caused by pathogenic variants in ABCC9 and KCNJ8 genes. These genes encode gain‐of‐function mutations in the regulatory (SUR2) and pore‐forming (Kir6.1) subunits of K_ATP channels, respectively, suggesting that channel‐blocking sulfonylureas could be a viable therapy. Here we report a neonate with CS, carrying a heterozygous ABCC9 variant (c.3347G>A, p.Arg1116His), born prematurely at 32 weeks gestation. Initial echocardiogram revealed a large patent ductus arteriosus (PDA), and high pulmonary pressures with enlarged right ventricle. He initially received surfactant and continuous positive airway pressure ventilation and was invasively ventilated for 4 weeks, until PDA ligation. After surgery, he still had ongoing bilevel positive airway pressure (BiPAP) requirement, but was subsequently weaned to nocturnal BiPAP. He was treated for pulmonary hypertension with Sildenafil, but failed to make further clinical improvement. A therapeutic glibenclamide trial was commenced in week 11 (initial dose of 0.05 mg^–1 kg^–1 day^–1 in two divided doses). After 1 week of treatment, he began to tolerate time off BiPAP when awake, and edema improved. Glibenclamide was well tolerated, and the dose was slowly increased to 0.15 mg^?1 kg^?1day^?1 over the next 12 weeks. Mild transient hypoglycemia was observed, but there was no cardiovascular dysfunction. Confirmation of therapeutic benefit will require studies of more CS patients but, based on this limited experience, consideration should be given to glibenclamide as CS therapy, although problems associated with prematurity, and complications of hypoglycemia, might limit outcome in critically ill neonates with CS.     

Effects of conventional physiotherapy, continuous positive airway pressure and non-invasive ventilatory support with bilevel positive airway pressure after coronary artery bypass grafting

BACKGROUND: Coronary artery bypass graft (CABG) surgery with the use of mammary arteries is associated with severe alteration of lung function parameters. The purpose of the present study was to compare the effect on lung function tests of conventional physiotherapy using incentive spirometry (IS) with non-invasive ventilation on continuous positive airway pressure (CPAP) and with non-invasive ventilation on bilevel positive airway pressure (BiPAP or NIV-2P), METHODS: Ninety-six patients were randomly assigned to 1 of 3 groups: NIV-2P (1 h/3 h), CPAP (1 h/3 h) and IS (20/2 h). Pulmonary function tests and arterial blood gases analyses were obtained before surgery. On the 1st and 2nd postoperative days, these parameters were collected together with cardiac output and calculation of venous admixture. RESULTS: For the 3 groups a severe restrictive pulmonary defect was observed during the 1st postoperative day. On the 2nd postoperative day, in opposition to IS, intensive use of CPAP and NIV-2P reduced significantly the venous admixture (P<0.001) and improved VC, FEV1 and PaO2 (P<0.01). CONCLUSION: We conclude that preventive use of NIV can be considered as an effective means to decrease the negative effect of coronary surgery on pulmonary function.     

机械通气在急性左心衰竭的临床应用研究

目的 探讨机械通气治疗急性左心衰竭的疗效。方法 对36例急性左心衰竭病人采用无创面（鼻）罩正压通气（BiPAP）,6例失败者给予气管插管机械通气治疗,全部病例同时给予常规药物治疗。并观察通气前、通气后20分钟、1个小时患者的临床症状变化、心率、呼吸频率、血压及1小时血气分析。结果 36例中30例采用BiPAP治疗成功,有6例改用气管插管机械通气治疗,也全部成功。结论 机械通气治疗急性左心衰竭不仅见效快,且抢救成功率高,值得推广应用。     

无创机械通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察

目的探讨双水平正压无创机械通气治疗慢性阻塞性肺病合并Ⅱ型呼吸衰竭的治疗价值。方法将60例慢性阻塞性肺病合并Ⅱ型呼吸衰竭患者随机平行分为治疗组和对照组各30例。对照组给予抗感染、祛痰、平喘、呼吸兴奋剂、低浓度持续吸氧、雾化吸人及支持治疗,治疗组在对照组治疗的基础上给予无创机械通气模式,观察两组患者心率、呼吸频率、血气分析等指标。结果双水平正压无创机械通气对提高Pa02和降低PaC02效果好,治疗组与对照组比较差异有统计学意义（P〈0．05）。结论双水平正压无创机械通气对慢性阻塞性肺病合并Ⅱ型呼吸衰竭的治疗效果好,值得l临床推广应用。     

BiPAP无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效观察

目的探讨双水平正压无创通气（BiPAP）对慢性阻塞性肺疾病（COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法70例COPDⅡ型呼衰患者中随机分成通气组和对照组，对照组给予常规抗感染、平喘、祛痰对症治疗和低浓度氧疗，通气组除了常规治疗外，加无创机械通气（BiPAP）治疗，采用通气口鼻面罩，设定参数S／T模式，呼吸频率14—20次／min，氧浓度40％左右，吸气压（IPAP）以10cm H2O开始，逐渐增加压力至25cmH2O，呼气压（EPAP）3—6cmH2O，每日上机2次，每次3h，7d为1个疗程。结果通气组治疗后动脉血气分析中pH值和PaO2逐渐上升，PaCO2值下降，临床症状改善，减轻呼吸肌疲劳，减慢呼吸频率和心率，呼吸困难减轻。结论本法治疗COPD合并Ⅱ型呼吸衰竭有效，减少气管插管或气管切开以及相应的并发症，减少病人的痛苦和医疗费用。     

BiPAP呼吸机联合硝普钠治疗高血压急性左心衰竭的临床分析

目的观察BiPAP呼吸机治疗高血压合并急性左心衰竭的疗效。方法49例老年高血压合并急性左心衰竭患者,常规治疗无效时加用经鼻（面）罩双水平气道正压通气治疗,准确记录治疗前后患者心率、血压及动脉血气等变化。结果49例患者治疗后心率、血压及动脉血气等指标明显改善（P〈0.05或P〈0.01）,患者病情明显好转,有效率100%。结论应用BiPAP呼吸机治疗老年高血压合并急性左心衰竭安全有效。     

过渡性气道内正压通气治疗睡眠呼吸暂停综合征

目的 观察睡眠呼吸暂停综合征（OSAS）患者应用经鼻气道正压通气（nCPAP)治疗的依从性。方法 25例OSAS患者和8例肥胖性低通气综合征（OHS）患者,在多导睡眠监测仪（PSG）监测下使用nCPAP治疗,对治疗开始不能耐受或治疗失败者,改用经鼻双水平正压通气（nBiPAP)。经1周或1个月治疗后,逐渐过渡到nCPAP。结果 （1）OHS组有较高的BMI、PaCO2,较低的FEV1、FEV1／FVC、PaO2与OSAS组比有明显差异性,P＜0．01,但两组AHI差异不明显。（2）33例患者均用nCPAP治疗,24例成功,9例（2例OSAS和7例OHS）失败改用nBiPAP治疗。两种方法治疗前后各指标比较有显著性差异（P＜0．01,P＜0．01）,组间无差异。9例治疗失败改用nBiPAP治疗后再过渡到nCPAP治疗的各项指标比较无显著性差异（P＞0．05,P＞0．05）。结论 nCPAP是治疗OSAS的一种有效方法,如果睡眠呼吸障碍并存在低通气或严重的高碳酸血症时,nBiPAP治疗可能是一种有效并易耐受的过渡方法,患者依从性良好。