无创性正压通气治疗急性呼吸衰竭患者的效果观察(1)
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[摘要] 目的：探讨无创性正压通气(NIPPV)治疗急性呼吸衰竭(ARF)的临床应用价值。方法：对我院80例ARF患者应用NIPPV进行治疗，比较治疗前后的各项监测指标变化。结果：成功75例，成功率达93.57%，5例患者由于无创通气不佳，而改用气管插管。临床症状缓解，气促、呼吸困难好转，发绀纠正，精神好转，均能平卧位或半卧位，肺部湿性啰音、哮鸣音明显减少。通气后各种监测指标均显著改善，差异有统计学意义(P<0.05)，pH值改变差异无统计学意义(P>0.05)。结论：NIPPV是有效救治ARF的机械通气方式，有着较高的成功率，可避免有创呼吸机的使用，但仍存在一定的失败率，所以应严格地掌握无创通气的适应证。
[关键词] 无创性正压通气；机械通气；急性呼吸衰竭
[中图分类号] R563.8[文献标识码]A [文章编号]1673-7210(2009)01(b)-026-02
The observation of non-invasive positive pressure ventilation in treatment of acute respiratory failure effect
LIU Ning
(Emergency Department, the Affiliated Tongji Hospital of Tongji University, Shanghai200065, China)
[Abstract] Objective: To discuss the effect of NIPPV in the treatment acute respiratory failure clinical value. Methods: Used ARF NIPPV to treat 80 patients of ARF in our hospital, compared the changes of monitoring indicators before and after treatment. Results: 75 cases were success, the success rate was 93.57 percent, 5 patients because of poor non-invasive ventilation, switch to intubation. Clinical symptoms eased, shortness of breath, difficulty in breathing improved, cyanosis corrected,the spirit improved, all-sits flat or semi-supine, lung noise decreased significantly. After the ventilation monitoring indicators were significantly improved, the differences were significant(P<0.05), the difference of pH change was not significant (P>0.05). Conclusion: NIPPV ARF is an effective treatment of mechanical ventilation, have a higher success rate, can avoid the use of a respirator, but there is still a certain failure rate, therefore, should strictly control the indications of non-invasive ventilation.
[Key words] Non-invasive positive pressure ventilation; Mechanical ventilation; Acute respiratory failure
急性呼吸衰竭(ARF)是临床常见的危重症，经气管插管或气管切开的有创正压机械通气(IPPV)给患者带来一定痛苦，且存在诸多并发症，无创性正压通气(NIPPV)是近年来ARF治疗的重要进展[1]。NIPPV是指在不需要气管插管的情况下，仅通过鼻面罩或口鼻面罩进行通气增加自主呼吸患者的通气。我院于2005年1月~2007年1月应用NIPPV对收治的80例ARF患者进行救治，取得满意疗效。现报道如下：
1资料与方法
1.1一般资料
80例均为我院收治的ARF患者，诊断符合中华医学会呼吸分会2000年诊断标准[2]，男54例，女26例；年龄16～82岁，平均51.5岁；病因包括慢性阻塞性肺病56例，重症哮喘10例，重症社区获得性肺炎8例，特发性肺纤维化并肺部感染6例；原发病：慢性阻塞性肺疾病(COPD)36例，急性呼吸窘迫综合征(ARDS)24例，急性心原性肺水肿12例，阻塞性睡眠呼吸暂停综合征(OSAS)4例 ......
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