目的 比较无创双水平正压通气（BiPAP）平均容积保证压力支持（AVAPS）模式与同步/时间控制（S/T）模式在肥胖的慢性阻塞性肺疾病（COPD）患者并发急性Ⅱ型呼吸衰竭中的治疗作用。 方法 选取2012年3月－2013年6月入院治疗且体质量指数（BMI）＞25 kg/m2的COPD发生急性Ⅱ型呼吸衰竭患者36例，按数字随机表法分为AVAPS组与S/T组。两组的基础治疗相同，AVAPS组采用飞利浦伟康V60呼吸机BiPAP AVAPS模式进行无创通气治疗，S/T组采用相同机型BiPAP S/T模式治疗。分别比较两组患者治疗1、6、24、72 h的格拉斯高昏迷（GCS）评分变化、血气分析结果、呼吸机监测数据。 结果 AVAPS组患者在最初治疗的6 h内GCS评分高于S/T组[1 h：（13.2 ± 0.6）、（11.9 ± 0.6） 分，P＜0.05；6 h：（13.8 ± 0.5）、（12.1 ± 0.6）分，P＜0.05]；24 h内的动脉血气酸碱度pH值改善[1 h：7.31 ± 0.03、7.26 ± 0.02，P＜0.05；6 h：7.37 ± 0.05、7.31 ± 0.04，P＜0.05]；24 h：7.40 ± 0.04、7.33 ± 0.03，P＜0.05]及二氧化碳分压下降[1 h：（65.2 ± 5.1）、（69.5 ± 4.1）mm Hg（1 mm Hg=0.133 kPa），P＜0.05；6 h：（61.4 ± 4.2）、（66.7 ± 4.3） mm Hg，P＜0.05；24 h：（58.2 ± 4.5）、（64.3 ± 5.4） mm Hg，P＜0.05）]优于S/T组，24 h内浅快呼吸指数低于S/T组[1 h：（35.2 ± 8.1）、（62.8 ± 13.2）次/（min·L），P＜0.05]；6 h（33.4 ± 7.8） 、（54.8 ± 11.6）次/（min·L），P＜0.05]，同时，减少了额外的人工参数调整次数[3.4 ± 1.1、1.2 ± 0.6），P＜0.05] 结论 对超重的COPD合并急性Ⅱ型呼吸衰竭患者采用AVAPS模式进行无创通气治疗，较S/T模式能更快地恢复意识水平，更快地降低血二氧化碳分压、改善pH值，同时减少了呼吸治疗师的人工操作次数。
目的:探讨慢性阻塞性肺病(慢阻肺)合并呼吸衰竭的临床护理及其预后之间的关系,为临床提供慢阻肺合并呼吸衰竭患者的护理经验及病例资料。方法:对2008年3月至2009年5月间在我院住院治疗的60例确诊为慢阻肺合并呼吸衰竭的患者,均采用贯序通气治疗,营养支持治疗,以及常规氧疗,根据护理期间营养支持治疗中是否接受静脉点滴脂肪乳而划分为两组，各30例。结果:接受完全肠道外营养患者的治疗时间较未接受者短，治愈率优于未接受者（927%比50%），没有死亡者（0比10%）。结论:有效的护理方法,尤其是恰当的营养支持治疗,对慢肺阻合并呼吸衰竭患者具有极其重要的意义。
摘要:目的：探讨纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中的临床应用价值。方法：237例慢阻肺合并重度呼吸衰竭患者,随机分为纤支镜经口引导气管插管组(纤支镜组)125例和喉镜经口引导气管插管组(喉镜组)112例,分别在纤支镜和喉镜引导下按常规进行气管插管术。结果：纤支镜组和喉镜组一次获得插管成功率分别为984%和920%(P＜005),平均插管时间分别为（613±391） min 和（926±415） min(P＜005)。纤支镜组有5例患者出现咽喉部少量出血,并发症发生率为40%;喉镜组共有12例发生并发症,并发症发生率为107%(P＜005),其中齿、舌、咽或喉部损伤6例,反射性呕吐致误吸2例,单侧肺通气1例,插入食管2例,心跳呼吸骤停1例。结论：纤支镜经口引导气管插管在慢阻肺合并重度呼吸衰竭救治中是一种简便快速、成功率高和并发症少的有效方法,值得临床推广应用。Abstract: Objective: To evaluate the efficacy of endotracheal intubation under fiberoptic bronchoscope through mouth in severe respiratory failure. Methods:Two hundreds and thirtyseven cases of severe respiratory failure were divided into two groups at random (fiberoptic bronchoscope group and laryngoscope group), 125 cases were intubated through mouth under fiberoptic bronchoscope, the others were intubated through mouth by laryngoscope. Results: The successful rates of endotracheal intubation were 98.4% and 92.0% in two groups respectively (P ＜005), the mean intubation timewere (613±391) min and (926±415) min respectively ( P ＜ 005), 4 cases in fiberoptic bronchoscope group appeared a little blood in throat, the complication rate was 32% 12 cases in the laryngoscope group had complications, the complication rate was 107%( P＜ 005). Among it, 6 cases had the injury of tooth, tongue, gullet and larynx.The cases of reflexvomiting were 2,pulmonary ventilation by single lung were 1, intubation in esophagus were 2, cardiopulmonary arrest were 1.Conclusions:Endotracheal intubation under fiberoptic bronchoscope through mouth was accurate, the fewer complications and effective for patients, and could be used widely in clinical applications.
目的:探讨双水平气道正压无创通气（BiPAP）对慢性阻塞性肺疾病（Chronic Obstructive Pulmonary Disease，COPD）合并Ⅱ型呼吸衰竭的治疗价值。方法：66例COPD合并Ⅱ型呼衰患者分成通气组和对照组，对照组给予常规抗感染、祛痰、平喘、肾上腺皮质激素、呼吸兴奋剂、低浓度持续吸氧等治疗，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12~18次/min，氧流量3~5 L/min，吸气压（IPAP）10~18 cmH2O，呼气压（EPAP）3~6 cm H2O，最初3日持续使用呼吸机，病情好转后6~20 h/d，通气天数为5~12天，观察治疗前后动脉血气分析指标变化。结果：通气组治疗后血气分析中pH值、SaO2、PaO2、PaCO2较治疗前均明显改善（Plt;0.01），其改善幅度明显优于对照组，临床症状亦明显改善。结论：双水平气道正压无创通气治疗COPD合并Ⅱ型呼吸衰竭疗效显著。
Forty critical patients with respiratory failure in the intensive care unit were randomly divided into two groups,Group A with administration of parenteral nutritino(PN) and Group B,no parenteral nutrition given.Blood gas analysis and respiratory monitoring showed that the respiratory rate,pH、PaO2、PaCO2 and HCO3- had no marked difference between the two groups.But in Group A there was a slight decrease of Pao2/FiO2 and a marked increase of A-aDO2 and the pulmonary shunt.This study indicates that the content of fat emulsion and hydrocarbon in PN may be the main factor that affects the respiratory function.
Objective To investigate the therapeutic effects of biphasic positive airway pressure (Bilevel) ventilation and volume ventilation plus [VV+，including volume control plus (VC+) and volume support (VS)] on respiratory failure in patients with chronic obstructive pulmonary disease (COPD).Methods 63 patients with COPD complicated by acute respiratory failure were intubated and underwent mechanical ventilation for at least 24 hours.At the first patients were underwent assist-control (A/C) ventilation for 2 to 4 hours to obtain the suitable basic ventilatory parameters.Meanwhile，the hemodynamics and oxygen dynamic parameters were measured.Then the patients were randomly allocated to three groups with 21 patients in each group and the ventilation mode was switched to Bilevel，VC+ and A/C mode correspondingly.The setting parameter was identical in three modes.In the process of weaning，patients in Bilevel group were ventilated with Bilevel and pressure support ventilation (PSV) mode at each pressure level，and subdivided into Bilevel and PSV 1 group accordingly.In VC+ group，the mode was switched to VS and PSV mode and subdivided into VC+ group and PSV 2 group,respectively.Every mode was run for 30 minutes while the ventilation function，blood gas exchange and lung mechanics index were measured.Results In the initial stage，the airway peak pressure (PIP) of Bilevel and VC+ mode obviously decreased，and the respiratory compliance was higher compared to the A/C mode. The effectiveness of Bilevel and A/C was equivalent in improving alveolar ventilation and oxygenation.The difference in the change of circulation function and blood gas between the two groups were not significant (Pgt;0.05).In the process of weaning，the effectiveness of Bilevel and VV+ was equal to PSV.The changes of breathing mode and blood gas between the two groups had no significant differences.Conclusions Bilevel and VV+ mode ventilation can be used in the whole mechanical ventilation for acute respiratory failure due to COPD with lower PIP，higher respiratory compliance compared to A/C model and similar performance as PSV during mechanical ventilation withdrawn.
Objective To study the effect of noninvasive positive pressure ventilation (NPPV) in chronic obstructive pulmonary disease (COPD) patients with hypercapnic coma secondary to respiratory failure.Methods COPD patients with or without coma secondary to respiratory failure were both treated by bi-level positive airway pressure (BiPAP) ventilation on base of routine therapy.There were 32 cases in coma group and 42 cases in non-coma group.Such parameters as arterial blood gas (ABG)，Glasgow coma scale (GCS)，time of NPPV therapy，achievement ratio，and adverse effects were investigated.Results 30 patients in the coma group were improved after NPPV treatment (26 cases recovered consciousness treated by BiPAP in 2 hours，3 cases recovered between 3~8 hours，1 case recovered after 24 hours).The parameters of ABG，the tidal volume and the minute ventilation volume were improved after BiPAP.The time of effective therapy was (9±4) days in the coma group and (7±3) days in the non-coma group with no significant difference (Pgt;0.05).The achievement ratio was similar in two groups (93.75% vs 97.62%，Pgt;0.05).But the incidence of gastrointestinal tympanites reached to a higher level in the coma group (80.5%) than the non-coma group (10.6%).Conclusion COPD patients with hypercapnic coma secondary to respiratory failure isn’t the absolute contraindication of NPPV treatment.
高频通气(HFV)是一种高通气频率和低潮气量的通气方式，其通气频率至少为机体正常呼吸频率的4倍，而潮气量近于或小于解剖死腔。其主要类型包括：高频正压通气、高频喷射通气和高频振荡通气等。其中，高频振荡通气(HFOV)是目前公认的最先进高频通气技术，在临床中应用最广泛。
Objective To study the clinical feasibility of invasive mechanical ventilation with bilevel positive airway pressure（BiPAP） non-invasive ventilator in the stable patients needing prolonged mechanical ventilation.Methods Eleven patients with respiratory failure admitted in intensive care unit（ICU）of our department，who needed prolonged mechanical ventilation，between Jun 2004 and Nov 2007 were enrolled in the study and followed until death or Jan 2008.The arterial blood gas analysis data，length of stay(LOS)，LOS after changing to BiPAP non-invasive ventilator（Synchrony，Harmony，RESPIRONICS，VPAP III ST-A，RESMED），survival time after discharge(or fulfilled the discharge standards) were reviewed retrospectively.Results The settings of inspiratory pressure，expiratory pressure and respiratory rate of non-invasive ventilation were 21.3 (16-26) cm H2O，4 cm H2O，and 16 min-1，respectively.The LOS (or up to the discharge standard) was (91.5±50.2) days.The LOS (or up to the discharge standard) after changing to BiPAP ventilator was (23.5±12.2) days.The mean survival time after discharge (or up to the discharge standard) was (353.1±296.5) days.Four patients were still alive up to the end of the study.The arterial pH，PaCO2，PaO2，and SaO2 were not significant different before and after changing to BiPAP ventilator.Conclusion The mechanical ventilation with BiPAP non-invasive ventilator via tracheotomy tube is an alternative choice for stable patients needing prolonged mechanical ventilation.