严重胸外伤致急性呼衰的机械通气治疗

目的 :探讨机械通气在抢救严重胸外伤致急性呼吸衰竭中的应用及意义。方法 :对 2 4例严重胸外伤致急性呼吸衰竭患者在常规治疗的同时加用机械通气辅助治疗 ,观察通气前后血气分析、生命体征及临床症状的变化。结果 :通气治疗后 ,2 1例患者症状明显改善 ,血气分析等参数与治疗前比较有显著性差异 (P <0 0 1) ,顺利脱机 ,抢救成功 2 1例 ,死亡 3例。结论 :机械通气治疗严重胸外伤致急性呼吸衰竭 ,能迅速改善患者呼吸困难症状和低氧血症 ,有效防止ARDS的发生和进一步发展 ,是抢救严重胸外伤致急性呼吸衰竭患者的一种最重要也是最具有肯定疗效的方法之一。     

经纤维支气管镜治疗术后急性呼吸衰竭疗效观察

目的 观察经纤维支气管镜治疗术后急性呼吸衰竭的疗效。方法 对ICU35例外科术后肺不张引起的呼吸衰竭患者在心电监护、经皮动脉血氧饱和度监测，机械通气后经纤维支气管镜吸收、钳夹堵塞支气管开口处的分泌物及痰痂，用温生理盐水灌注后注药。结果 全部患者呼吸困难消失，呼吸音恢复正常或较前增强，术后动脉血气恢复正常。结论 经纤维支气管镜治疗外科术后肺不张所致急性呼吸衰竭是一种安全、经济、简单有效的方法。     

联合机械通气和冬眠疗法在腹部术后并发急性呼吸窘迫综合征治疗中的应用

目的：探讨联合机械通气和冬眠疗法在腹部术后并发急性呼吸窘迫综合征（ARDS）治疗中的应用价值。方法：对35例腹部术后并发ARDS患者使用机械通气和冬眠疗法，并进行血气分析和多功能监护仪监测，分析其治疗效果。结果：全组死亡5例，病死率14．3％，机械通气并发症13例，并发症发生率37．1％，机械通气时间3－26天，平均7．2天。结论：腹部术后并发ARDS是外科的严重并发症，正确使用机械通气和冬眠疗法是降低病死率的有效措施。     

创伤性肺不张76例的护理

目的:探讨创伤性肺不张原因和护理方法.方法:对我科收治的创伤性肺不张76例作回顾性分析.结果:76例肺不张原因:肺挫伤57例,支气管破裂19例,行胸腔引流37例,气管切开16例,纤维支气管镜检查51例,肋悬吊牵引11例、内固定6例,机械通气16例,剖胸术21例.主要护理措施为呼吸物理治疗.护理前后Pa02分别为(56.6±6.6)mmHg和(93.2±4.1)mmHg(P<0.01).死亡2例(2.6%),74例痊愈.结论:早期护理要点为观察发现肺不张,纤维支气管镜检鉴别支气管破裂和肺挫伤.后者主要护理内容除一般呼吸物理治疗,还包括支气管镜吸痰、气管切开和机械通气.     

机械通气内固定治疗连枷胸合并呼吸衰竭的呼吸管理

目的：探讨机械通气内固定治疗连枷胸合并呼吸衰竭的呼吸管理。方法：从护理的角度探讨呼吸机应用、气道管理、呼吸监测、镇静剂应用等在治疗连枷胸合并呼吸衰竭患者过程中的作用。结果：32例连枷胸合并呼吸衰竭患者中有30例经机械通气治疗5～16d后一次性成功脱机，痊愈出院；2例分别因重度颅脑损伤及失血性休克死亡。结论：护理中加强呼吸管理是利用机械通气内固定成功救治连枷胸合并呼吸衰竭患者的关键。     

肺癌术后机械通气患者的气道管理

治疗肺癌的主要方法是手术治疗 ,行肺叶切除或一侧全肺切除 ,术后肺活量、最大通气量减少 ,残气量增加 ,肺呼吸功能降低。如果不能及时清除呼吸道分泌物 ,可致肺不张、肺部感染和呼吸衰竭等严重并发症。因此 ,应加强术后机械通气患者的气道管理。现将持续呼吸机治疗期间气道湿化 ,有效吸痰 ,防止痰痂形成 ,预防肺不张的护理体会总结如下。1　临床资料1997年 1月至 2 0 0 1年 12月我院共为 5 2 0例肺癌患者行手术治疗。术后机械通气 2 1例 ,男 16例 ,女 5例 ,5 3～ 73岁 ,平均 64岁。机械通气时间3ｈ～ 7ｄ ;气管插管 8例 ,气管切开 13例 ;术…     

急性呼吸窘迫综合征患者机械通气和营养支持治疗37例分析

目的探讨急性呼吸窘迫综合征（ARDS）患者机械通气和营养支持治疗的临床特点及治疗效果。方法回顾性分析37例ARDS患者经机械通气和营养支持治疗的临床资料。结果37例ARDS机械通气患者1次脱机成功者30例,2次脱机成功者5例,3次脱机成功者2例。机械通气3—10d,无一例依赖呼吸机。全胃肠外营养（TPN）支持4-12d,TPN支持期间合并高血糖5例,消化道出血4例,肺感染、呼吸衰竭5例,无一例中心静脉置管并发症。结论机械通气和营养支持治疗ARDS临床效果较好。但应注意营养供给方式的选择。     

机械通气辅助治疗新生儿呼吸衰竭200例临床分析

目的：总结机械通气辅助治疗新生儿呼吸衰竭的效果及并发症。方法：将我院2000～2003年4月NICU成立以来200例机通气患儿进行临床分析。结果：200例中，痊愈180例，放弃治疗10例，死亡8例，确诊相关性肺炎136例，并发气胸8例，肺不张5例，支气管肺发育不良2例。结论：机械通气是抢救新生儿呼吸衰竭的重要手段之一，但如使用不当，可引起严重并发症，甚至死亡，机械通气患儿呼吸机相关性肺炎发生率仍较高，病原菌的分布和耐药性也有所变化，应加以预防和控制。     

创伤性气管支气管损伤的急诊手术治疗

目的探讨气管支气管损伤的急诊外科治疗,评价急诊手术治疗效果。方法对我院手术的9例气管支气管损伤患者的临床资料进行分析。结果7例患者急诊剖胸行气管支气管修补术,术后并发左下肺不张1例,经纤维支气管镜吸痰治愈,全组无死亡,术后无支气管胸膜瘘及狭窄发生。结论急诊剖胸气管支气管修补术是治疗气管支气管损伤的重要方法,安全、并发症少。     

经纤维支气管镜灌洗治疗急性大面积肺不张25例

胸、腹部外伤、手术 ,机械通气以及呼吸道炎症常发生急性大面积肺不张 ,及时应用纤维支气管镜吸引灌洗是抢救的重要措施 ,疗效显著 ,现将我院救治的 2 5例报告如下。1　资料与方法1.1　病例选择　 2 5例中男 19例 ,女性 6例 ,年龄 16～ 76岁 ,平均 44岁。病种包括胸、腹、脑部外伤及术后 14例 ,机械通气撤机后 3例 ,脑血管意外昏迷 4例。慢性支气管炎、阻塞性肺气肿、肺心病 4例。全部病例经Ｘ线及临床检查确诊 ,肺不张大于 1个叶。1.2　方法　病房床边急诊纤维支气管镜检查仪器包括ＯｌｙｍｐｕｓＳＢＦ Ｐ2 0 型纤支镜及其配套附件 ,心电…     

机械通气在肾移植术后间质性肺炎合并急性呼吸窘迫综合征抢救中的价值探讨

目的 :探讨机械通气在抢救肾移植术后间质性肺炎合并急性呼吸窘迫综合征 (ARDS)中的价值。方法 :收集 16例综合 ICU(GICU)内肾移植术后因间质性肺炎合并 ARDS患者的临床资料 ,分析与比较机械通气后缺氧改善情况等 ,了解和判断机械通气治疗的价值及影响抢救成功率的主要环节。结果 :16例患者中 ,15例应用了机械通气与不同水平的呼气末正压〔 PEEP,4～ 15 cm H2 O(1cm H2 O=0 .0 98k Pa)〕治疗 ,1例未用机械通气治疗 ;机械通气治疗〔1～ 87d,平均 (15 .4± 2 1.1) d〕与生存时间〔1～ 194 5 d,平均 (15 4 .4± 4 97.1) d〕不等 ;仅 1例痊愈 (6 .7% ) ,14例死亡 (93.3% )。死亡原因分析提示 ,在应用机械通气治疗的患者中 ,病程短(≤ 3d)的患者 (3例 ) ,导致死亡的直接因素为非呼吸因素 (循环和中枢神经 ) ;未应用机械通气治疗的患者(1例 )导致死亡的直接原因为缺氧。分析 1例抢救成功病例的主要经验在于及时应用机械通气并纠正了缺氧 ,为原发病的治疗赢得了时间。结论 :机械通气抢救肾移植术后间质性肺炎合并 ARDS的主要价值在于纠正缺氧 ,病原学诊断与治疗方面的困难可能是抢救成功率低的主要原因。     

High-frequency jet ventilation for differential lung ventilation

High-frequency jet ventilation using a jet injector located at the right mainstem bronchus was superimposed on standard mechanical ventilation to ventilate the injured lung of a patient with unilateral massive atelectasis secondary to pulmonary hemorrhage. This technique of differential ventilation markedly improved arterial oxygenation in this patient and may prove to be a simpler modality of respiratory support in patients who have respiratory failure from unilateral lung disease.     

Pathophysiology of adult respiratory distress syndrome after sepsis and surgical operations

To describe the natural history of adult respiratory distress syndrome (ARDS) from the circulatory viewpoint, we measured hemodynamic and oxygen transport variables in a series of 126 postoperative and 65 septic ARDS patients. All patients had hypoxemia unresponsive to conservative measures and required mechanical ventilation. Data from this series were compared with data from normal healthy volunteers and from postoperative patients who did not develop ARDS. In addition, the temporal sequence of cardiorespiratory changes in the ARDS patients was observed for a 48-h period before and after ARDS was diagnosed. Before the development of ARDS, both postoperative and septic patients exhibited hypovolemia, pulmonary vasoconstriction, suboptimal myocardial performance, and reduced oxygen delivery and consumption relative to the increased needs of the hypercatabolic state. Because these antecedent changes were greater in ARDS patients who died, their early correction (in addition to standard ventilatory support) may prevent the development of ARDS and decrease its mortality.     

急性呼吸衰竭纤维支气管镜肺段冲洗乌司他丁干预的临床研究

目的 评价纤维支气管镜肺段冲洗联合机械通气乌司他丁干预对控制胸腹部手术后急性呼吸衰竭、防治多脏器功能障碍综合征（MODS）及降低其病死率的作用.方法 56例胸腹部手术后急性呼吸衰竭患者随机分为纤维支气管镜肺段冲洗联合机械通气组（n=30）和纤维支气管镜肺段冲洗联合机械通气乌司他丁干预组（n=26）,比较两组患者呼吸力学、动脉血气及血流动力学的变化.观察两组患者肺及肺外脏器功能改善率、ICU病死率及其死亡原因等.结果 两组患者年龄和APACHE Ⅱ评分比较差异无显著性（P＞0.05）;纤维支气管镜肺段冲洗联合机械通气乌司他丁干预组对患者呼吸力学、动脉血气及血流动力学的影响均优于单纯使用纤维支气管镜肺段冲洗联合机械通气组;乌司他丁治疗组多脏器功能衰竭（MODF）的病死率为15.3%,明显低于对照组（25.6%,P＜0.05）.结论 纤维支气管镜联合机械通气乌司他丁干预能进一步改善胸腹部手术后急性呼吸功能衰竭患者的呼吸力学、动脉血气及血流动力学指标,并在防治MODS及降低急性呼吸衰竭患者病死率上有显著临床效果.     

Non-invasive negative and positive pressure ventilation in the treatment of acute on chronic respiratory failure

Objective To investigate in clinical practice the role of non-invasive mechanical ventilation in the treatment of acute respiratory failure on chronic respiratory disorders.Design An 18 months prospective cohort study.Setting A specialised respiratory intensive care unit in a university-affiliated hospital.Patients A total of 258 consecutive patients with acute respiratory failure on chronic respiratory disorders.Interventions Criteria for starting non-invasive mechanical ventilation and for endotracheal intubation were predefined. Non-invasive mechanical ventilation was provided by positive pressure (NPPV) ventilators or iron lung (NPV).Results The main characteristics of patients (70% with chronic obstructive pulmonary disease) on admission were (mean, SD or median, 25th–75th centiles): pH 7.29 (0.07), PaCO₂ 83 mm Hg (19), PaO₂/FiO₂ 198 (77), APACHE II score 19 (15–24). Among the 258 patients, 200 (77%) were treated exclusively with non-invasive mechanical ventilation (40% with NPV, 23% with NPPV, and 14% with the sequential use of both), and 35 (14%) with invasive mechanical ventilation. In patients in whom NPV or NPPV failed, the sequential use of the alternative non-invasive ventilatory technique allowed a significant reduction in the failure of non-invasive mechanical ventilation (from 23.4 to 8.8%, p=0.002, and from 25.3 to 5%, p=0.0001, respectively). In patients as a whole, the hospital mortality (21%) was lower than that estimated by APACHE II score (28%).Conclusions Using NPV and NPPV it was possible in clinical practice to avoid endotracheal intubation in the large majority of unselected patients with acute respiratory failure on chronic respiratory disorders needing ventilatory support. The sequential use of both modalities may increase further the effectiveness of non-invasive mechanical ventilation.Electronic Supplementary Material Supplementary material is available in the online version of this article at http://dx.doi.org/10.1007/s00134-003-2145-9     

Outcome of mechanical ventilation for acute respiratory failure in patients with pulmonary fibrosis

OBJECTIVE: During the course of idiopathic pulmonary fibrosis patients may need invasive mechanical ventilation because of acute respiratory failure. We reviewed the charts of all patients with idiopathic pulmonary fibrosis admitted to our ICU for mechanical ventilation to describe their ICU course and prognosis. DESIGN AND SETTING: Retrospective, observational case series, from December 1996 to March 2001, in an 18-bed medical ICU in a tertiary university hospital. PATIENTS: Fourteen consecutive patients with idiopathic ( n=11) or secondary ( n=3) pulmonary fibrosis admitted to the medical ICU for mechanical ventilation. MEASUREMENTS AND RESULTS: Relevant factors of history and hospital course such as diagnostic and therapeutic interventions were retrieved as well as laboratory and radiological results. All patients were admitted for severe acute hypoxemic respiratory failure (PaO(2)/FIO(2) 111+/-64 mmHg), with a high clinical suspicion of lower respiratory tract infection. Despite ventilatory support and adjunctive therapies (antibiotics, steroids, or immunosuppressive drugs), all patients gradually worsened and eventually died in the ICU after a mean stay of 7.6+/-4.6 days. CONCLUSIONS: In this study mechanical ventilation for acute respiratory failure in pulmonary fibrosis patients was associated with a 100% mortality, despite aggressive therapeutic and diagnostic procedures.     

纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用

目的探讨纤维支气管镜引导下经鼻气管插管机械通气在COPD并呼吸衰竭中应用。方法2008年1月至2009年10月收治的慢性阻塞性肺疾病（COPD）并发Ⅱ型呼吸衰竭120例分为纤维支气管镜插管组60例采用纤维支气管镜引导下经鼻气管插管,经口气管插管组60例采用经口气管插管,进行观察。结果纤维支气管镜插管组纤维支气管镜引导下经鼻气管插管全部病例均一次插管成功,一次性插管成功率100％,插管时间1—2min,无一例插管时发生心跳、呼吸骤停,血压下降,气管破裂,气管损伤,咯血等并发症。经口气管插管组由于患者气道分泌物过多、肥胖等原因咽喉暴露不充分出现插管困难7例;插管时发生发生心跳、呼吸骤停3例。结论纤维支气管镜引导下经鼻气管插管明显优于经口管插管具有操作简单,创伤小,并发症发生少,同时可以清理呼吸道,以迅速纠正阻塞、改善通气。     

Respiratory insufficiency in neuronopathic and neuropathic disorders

Twenty-nine patients with a neuronopathic or neuropathic disorder were referred for assessment of respiratory insufficiency between 1978 and 1994. Diagnoses included spinal muscular atrophy (6), chronic idiopathic demyelinating neuropathy (4), Vialetto-van Laere syndrome (3), hereditary motor and sensory neuropathy (3) and a miscellaneous group (5). We also describe seven patients with Guillain-Barre syndrome (GBS) who required long-term ventilatory support for over 6 months to 7 years after the initial illness. Respiratory insufficiency occurred as a consequence of respiratory muscle weakness, impaired bulbar function and restrictive lung defects. In some groups presentation was with progressive nocturnal hypoventilation culminating in acute respiratory failure. Five patients with GBS or chronic idiopathic demyelinating neuropathy were weaned from ventilatory support up to 18 months after the initial illness. The remaining 24 patients required continuous or nocturnal ventilatory support using intermittent positive-pressure ventilation (13), negative pressure ventilation (4), nasal-mask-delivered intermittent positive-pressure ventilation (4), nasal-mask-delivered continuous positive-pressure ventilation (3), mouthpiece-assisted ventilation by day (2) and rocking bed (1). None have been weaned from support after a period of ventilation ranging from one month to 10 years. Eight patients have subsequently died.      

机械通气治疗老年肺癌术后合并呼吸衰竭的护理体会

目的探讨老年肺癌术后合并急性呼吸衰竭患者早期应用呼机械通气治疗的护理经验。方法回顾分析2004年3月至2009年12月本院老年肺癌术后合并呼吸衰竭18例临床资料,均行机械通气,同时控制肺部感染和给予营养支持。结果 16例治愈(88.9%),1例死亡,1例自动出院。结论老年肺癌术后合并呼吸衰竭,应早期给予机械通气治疗,合理调整参数,注意无菌操作,加强护理,同时应用有效抗生素和营养支持。早期积极治疗有望降低病死率。     

Experiences with severe P. falciparum malaria in the intensive care unit

Objective: To review the clinical profiles and therapies instituted for patients with severe malaria admitted to an ICU.¶Design: Retrospective study.¶Setting: Internal ICU of a tertiary care centre.¶Patients and participants: Between January, 1992, and February, 1999, 104 patients with malaria were admitted to the General Hospital of Vienna. Sixty-nine patients suffered from Plasmodium falciparum malaria (66 %), seven of these were admitted to the ICU.¶Measurement and results: Seven patients were admitted to the ICU, of whom three died (4 % in hospital case-fatality rate). Four patients required mechanical ventilation because of respiratory insufficiency and adult respiratory distress syndrome (ARDS), of whom three died. Three patients were treated with inhaled nitric oxide (NO) and kinetic therapy; one patient required extracorporeal veno-venous oxygenation. All patients who died required haemofiltration because of acute renal failure.¶Conclusion: As P. falciparum is a potentially life-threatening disease, reliable criteria for ICU admission should be defined and risk factors identified. Early ICU monitoring should be attempted, especially under the following conditions: (1) lack of clinical response to anti-malarial treatment within 48 h and/or (2) any signs of neurological disturbance (hypoglycaemia excluded). Prospective multicentre trials and guidelines for supportive intensive care are urgently needed.