BiPAP通气联合纳洛酮治疗Ⅱ型呼吸衰竭合并肺性脑病的临床价值分析

目的 探究BiPAP通气联合纳洛酮治疗Ⅱ型呼吸衰竭合并肺性脑病的临床价值.方法 选取我院2013-07—2015-07收治的70例II型呼吸衰竭合并肺性脑病患者,按照患者住院的先后顺序分成观察组和对照组各35例.观察组通过纳洛酮联合BiPAP治疗,对照组给予常规疗法治疗,对比2组临床疗效.结果 观察组和对照组的治疗成功率分别为74.29%、42.86%,差异具有统计学意义(P<0.05).2组气管插管率、病死率比较,差异有统计学意义(P<0.05).治疗过程中,2组均未产生不良反应.结论 BiPAP联合纳洛酮治疗Ⅱ型呼吸衰竭合并肺性脑病,临床疗效显著,值得应用.     

无创正压通气治疗急性脑卒中合并慢性阻塞性肺疾病呼吸衰竭的疗效

目的:观察无创正压通气(NIPPV)治疗急性脑卒中合并慢性阻塞性肺疾病(COPD)呼吸衰竭的临床疗效。方法:分析67例急性脑卒中合并COPD呼吸衰竭(急性脑卒中+COPARF组)、59例急性脑卒中合并中枢性呼吸衰竭(急性脑卒中+CRF组)和65例COPD合并呼吸衰竭(对照组)患者应用BiPAP呼吸机治疗的疗效。对治疗前和治疗后1~6 h生命体征和动脉血气分析的变化及3组患者病死率、治疗有效平均通气时间、存活者和病死者的平均机械通气时间进行统计学分析。结果:急性脑卒中+COPARF组、急性脑卒中+CRF组和对照组的治疗有效率分别为71.64%、30.50%和72.30%;急性脑卒中+COPARF组疗效和对照组比较,差异无统计学意义(P>0.05);急性脑卒中+CRF组疗效与另2组比较,差异有显著统计学意义(P<0.01)。病死率分别为22.38%、45.76%和15.38%;急性脑卒中+COPARF组病死率与对照组比较,差异无统计学意义(P>0.05);急性脑卒中+CRF组病死率与另2组比较,差异有统计学意义(P<0.01)。治疗有效平均通气时间,急性脑卒中+COPARF组与对照组比较和急性脑卒中+CRF组与另2组比较,均差异有统计学意义(P<0.05)。急性脑卒中+COPARF组存活者的平均机械通气时间、病死者生前平均使用机械通气时间与另2组比较,均差异有统计学意义(P<0.05)。结论:NIPPV治疗急性脑卒中合并COPD呼吸衰竭患者的临床疗效肯定。     

无创双水平正压通气治疗慢性阻塞性肺疾病并发肺性脑病的疗效及安全性

目的：观察无创双水平正压通气（BiPAP）在慢性阻塞性肺疾病（COPD）合并肺性脑病治疗中的疗效及安全性。方法将84例家属拒绝有创通气的COPD合并肺性脑病患者按随机数字表法分为对照组和观察组各42例,对照组给予纳洛酮、尼可刹米等药物治疗,观察组在药物治疗基础上联合BiPAP应用,对比2组疗效及安全性。结果观察组抢救成功率88·09％、48 h显效率45·24％、48 h总有效率85·72％分别优于对照组的64·28％、19·05％、54·76％,治疗24 h对照组存活34例,观察组存活38例,观察组存活者 pH值、PaCO2、PaO2、GCS评分均较对照组改善更为明显,差异均有统计学意义（ P＜0·05）,2组安全性差异无统计学意义（P＞0·05）。结论 BiPAP可安全、快速纠正COPD合并肺性脑病患者呼吸衰竭,促进意识恢复,提高疗效,建议对拒绝有创通气患者谨慎选用。     

BiPAP无创机械通气联合纳洛酮醒脑静治疗肺性脑病32例

肺性脑病是AECOPD合并呼吸衰竭的危重表现,也是肺病患者死亡的重要原因,病死率高达50%以上[1]。近年来,BiPAP无创机械通气在AECOPD清醒患者的治疗中得到了广泛的应用,但对于肺性脑病多采取有创呼吸机。本人自2006-11—2012-12采用BiPAP无创机械通气联合纳洛酮醒脑静治疗肺性脑病32例,疗效显著,现报告如下。     

无创通气治疗COPD呼衰合并肺性脑病疗效观察

目的 探讨无创双水平正压通气治疗慢阻肺呼衰合并肺性脑病的疗效.方法 63例慢阻肺呼衰合并肺性脑病采用BiPAP无创通气治疗,比较上机前、上机后4小时、撤机后24小时血气变化及临床症状、体征的改变.结果 采用BiPAP无创通气治疗后较治疗前临床症状、体征及血气分析结果 明显改善.结论 BiPAP无创通气治疗COPD呼衰合并肺性脑病正成为一线治疗方法 .     

纳洛酮联合BiPAP治疗慢性阻塞性肺疾病合并早期肺性脑病的临床价值

目的研究双水平无创正压通气(BiPAP)联合纳洛酮在慢性阻塞性肺疾病合并早期肺性脑病的临床价值。方法将我院近年来呼吸重症监护室收治的48例慢阻肺呼吸衰竭合并早期肺性脑病患者随机分为2组,对照组采用双水平无创正压通气及常规治疗,治疗组采用双水平无创正压通气联合纳洛酮及常规治疗。结果治疗组神志恢复时间及血气改善时间、有创呼吸机使用率明显低于对照组。结论双水平无创气道正压通气联合纳洛酮治疗慢性阻塞性肺疾病合并早期肺性脑病可以缩短血气改善时间,促进肺性脑病患者神志恢复,降低患者的有创呼吸机使用率,扩展无创正压通气的应用范围。     

呼吸机支持对脑梗死合并COPD的临床疗效及对CRP Hcy的影响

目的探讨呼吸机支持治疗脑梗死合并慢性阻塞性肺疾病(COPD)的临床疗效及对C-反应蛋白(CRP)及同型半胱氨酸(Hcy)的影响。方法选取60例脑梗死合并COPD患者作研究对象,采用随机数字法将其分为A组和B组,每组30例。A组在常规治疗的基础上给予有创呼吸机辅助呼吸支持,B组在常规治疗的基础上给予无创呼吸机辅助呼吸支持。对比2组治疗前及治疗后24hCRP、Hcy水平的变化,对2组治疗后血气分析值进行比较。结果治疗前2组CRP、Hcy表达量均低于治疗前,差异有统计学意义(P0.05);2组治疗后PaO2、PaCO2水平均优于治疗前,差异有统计学意义(P0.05)。A组PaO2及PaCO2改善程度优于B组,差异有统计学意义(P0.05)。结论有创呼吸机辅助呼吸支持较无创呼吸机辅助呼吸可更明显降低脑梗死合并COPD患者的CRP及Hcy水平,更有效促进血气分析值恢复正常。     

无创通气对慢阻肺呼吸衰竭并肺性脑病的疗效观察

目的 探讨BIPAP呼吸机面罩式无创通气在治疗慢性阻塞性肺疾病(COPD)呼吸衰竭并肺性脑病中的疗效。方法 56例COPD呼衰并肺性脑病患者中随机抽取28例进行无创双水平气道正压(BIPAP)呼吸机面罩式无创通气治疗。比较上机前、后4h及撤机后24h的PH值、PaCO2、PaO2值及SaO2,并观察临床症状变化、死亡率、插管率及住院天数情况,并与对照组常规综合治疗后的结果作比较。结果 BIPAP组治疗后与治疗前比较临床症状、生命体征及血气指标明显改善。插管率、死亡率及住院天数均显著低于对照组。结论 无创面罩通气对COPD呼衰并肺性脑病患者能够改善临床症状、二氧化碳潴留及低氧血症,减少气管插管率、死亡率及住院天数。临床使用方便,依从性好,不良反应少,正在成为COPD呼衰并肺性脑病患者的一线治疗方法。     

无创机械通气在重症肌无力危象治疗中的疗效

目的 研究应用双水平气道正压 通气(BiPAP)治疗重症肌无力所致急性呼吸衰竭的治疗作用。方法 回顾性分析2011-2013年收治的重症肌无力合并急性呼吸衰竭患者而使用双水平气道正压通气(BiPAP)治疗23例,比较他们BiPAP 治疗前、治疗后2 h的动脉血气分析数据的变化,心率、呼吸频率及治疗2周后症状改善情况(QMG评分),并进行统计学分析。结果 23例患者中有18例无创机械通气治疗前患者心率(HR),呼吸频率(RR),血浆pH值,动脉血氧分压(PaO₂),动脉血二氧化碳分压(PaCO₂)分别为(108.7±17.6)次/min,(25.8±5.3)次/min,7.31±0.04,(58.7±13.3)mmHg,(53.8±7.8)mmHg; 治疗后2小时患者HR、RR、血浆pH值PaO₂、PaCO₂分别为(83.4±15.9)次/min,(21.1±4.9)次/min,7.36±0.04,(83.4±15.7)mmHg,(38.6±7.0)mmHg,较治疗前均明显改善。(P<0.05),治疗前患者QMG评分为17.94±2.07分,治疗2周后患者QMG评分为(10.06±2.71)分,也较治疗前有显著改善。(P<0.01)。结论 BiPAP治疗对重症肌无力所致急性呼吸衰竭的有重要治疗价值,能有效改善患者的呼吸功能。     

中枢性呼吸衰竭和周围性呼吸衰竭患者机械通气的治疗比较

目的对ICU病房及各科需使用呼吸机治疗的中枢性呼吸衰竭和周围性呼吸衰竭患者使用机械通气治疗的时间和转归进行比较。方法 2003年8月至2005年8月使用有创性呼吸机治疗的全部226例患者分为中枢性呼吸衰竭和周围性呼吸衰竭两组,回顾性分析呼吸机的使用时间及机械通气治疗后的转归。结果中枢性呼吸衰竭患者120例,机械通气的平均时间为（9.1±19.3）d,周围性呼吸衰竭患者106例,机械通气时间为（5.4±10.9）d,P=0.038,前者死亡率为50%,后者死亡率为21.3%,P〈0.005。结论与周围性呼吸衰竭患者相比,中枢性呼吸衰竭患者机械通气时间长、死亡率高。     

纳洛酮联合无创机械通气治疗AECOPD并发轻中度肺性脑病疗效观察

目的观察纳洛酮联合BIPAP无创机械通气治疗慢性阻塞性肺疾病急性加重期（AECOPD）并发轻中度肺性脑病的临床疗效。方法选择AECOPD并发呼吸衰竭轻中度肺性脑病患者43例,均在有效抗感染、解痉平喘等常规治疗的基础上予以纳洛酮及BIPAP无创呼吸机辅助通气。分别在通气前、后3h、24h及72h后评价患者症状、意识状况、动脉血气分析。结果 43例中好转40例,失败3例,有效率93.02%,治疗3h后呼吸困难程度、血气指标有所改善,72h后明显好转,差异有统计学意义（P〈0.05）。结论纳洛酮联合BIPAP无创正压机械通气可迅速缓解患者呼吸困难、改善患者意识状态及呼吸肌疲劳情况,是治疗AECOPD并发轻中度肺性脑病的一种有效治疗措施。     

Noninvasive ventilation in myasthenic crisis

BACKGROUND: Myasthenic crisis (MC) is often associated with prolonged intubation and with respiratory complications. OBJECTIVES: To assess predictors of ventilation duration and to compare the effectiveness of endotracheal intubation and mechanical ventilation (ET-MV) with bilevel positive airway pressure (BiPAP) noninvasive ventilation in MC. DESIGN: Retrospective cohort study. SETTING: Academic research. Patients We reviewed consecutive episodes of MC treated at the Mayo Clinic, Rochester, Minnesota. MAIN OUTCOME MEASURES: Collected information included patients' demographic data, immunotherapy, medical complications, mechanical ventilation duration, and hospital lengths of stay, as well as baseline and preventilation measurements of forced vital capacity, maximal inspiratory and expiratory pressures, and arterial blood gases. RESULTS: We identified 60 episodes of MC in 52 patients. BiPAP was the initial method of ventilatory support in 24 episodes and ET-MV was performed in 36 episodes. There were no differences in patient demographics or in baseline respiratory variables and arterial gases between the groups of episodes initially treated using BiPAP vs ET-MV. In 14 episodes treated using BiPAP, intubation was avoided. The mean duration of BiPAP in these patients was 4.3 days. The only predictor of BiPAP failure (ie, requirement for intubation) was a Pco(2) level exceeding 45 mm Hg on BiPAP initiation (P= .04). The mean ventilation duration was 10.4 days. Longer ventilation duration was associated with intubation (P= .02), atelectasis (P< .005), and lower maximal expiratory pressure on arrival (P= .02). The intensive care unit and hospital lengths of stay statistically significantly increased with ventilation duration (P< .001 for both). The only variable associated with decreased ventilation duration was initial BiPAP treatment (P< .007). CONCLUSIONS: BiPAP is effective for the treatment of acute respiratory failure in patients with myasthenia gravis. A BiPAP trial before the development of hypercapnia can prevent intubation and prolonged ventilation, reducing pulmonary complications and lengths of intensive care unit and hospital stay.     

Magnetic resonance spectroscopy in adult-onset citrullinemia: elevated glutamine levels in comatose patients

BACKGROUND: Adult-onset type II citrullinemia is an inborn error of urea cycle metabolism that can lead to hyperammonemic encephalopathy and coma. However, type II citrullinemia is rare outside Japan, and diagnosis and treatment can be delayed. Magnetic resonance spectroscopy may be a useful adjunct to magnetic resonance imaging, and has been applied to noninvasively study chemical metabolism in the human brain. PATIENTS: We describe 2 patients with type II citrullinemia who presented with episodic postprandial somnolence and coma. Diffusion-weighted magnetic resonance imaging showed bilaterally symmetrical signal abnormalities of the insular cortex and cingulate gyrus. On magnetic resonance spectroscopy, glutamine and glutamate levels were elevated, and choline and myo-inositol levels were decreased. The diagnosis of citrullinemia was confirmed based on elevated plasma ammonia and citrulline levels. CONCLUSION: Characteristic features found at the time of magnetic resonance imaging and magnetic resonance spectroscopy may be helpful for early diagnosis of type II citrullinemia in adult patients who present with hyperammonemic encephalopathy and coma.     

BiPAP in early guillain-barré syndrome may fail

BACKGROUND: Non-invasive mechanical ventilation (BiPAP) has been introduced for use in neuromuscular respiratory disease such as amyotrophic lateral sclerosis and myasthenia gravis. There is no experience in Guillain-Barré syndrome. METHODS: We describe for the first time the use of BiPAP to assist in the work of breathing in two consecutive patients with progressing Guillain-Barré syndrome (GBS) and marginal pulmonary function. RESULTS: Our initial attempts to use BiPAP in GBS and early neuromuscular respiratory failure were totally unsuccessful. There was marked initial improvement; however, emergency intubation was needed in both patients, one of which became acutely cyanotic. CONCLUSIONS: Until more experience is available, we strongly warn against using BiPAP in deteriorating patients with GBS.     

Severity of nocturnal hypoxia and daytime hypercapnia predicts CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome

BackgroundObstructive sleep apnea (OSA) and chronic obstructive pulmonary disease (COPD) are independent risk factors for cardiovascular diseases. In patients with OSA and concurrent COPD, continuous positive airway pressure (CPAP) therapy improves survival. Nevertheless, a significant proportion of such patients do not tolerate CPAP. The aim of the present study was to analyze early predictors of CPAP failure in patients with OSA and concurrent COPD, and to evaluate the effects of bilevel positive airway pressure (BiPAP) in this high-risk group of patients.MethodsA post hoc analysis from the database of 2100 patients diagnosed with OSA between 2012 and 2014 identified 84 subjects as having concomitant COPD and meeting inclusion criteria. Demographic data, pulmonary function tests, OSA parameters, blood gases, response to CPAP and BiPAP titration, and two months of therapy were collected. A multivariate model was generated to find determinants of CPAP failure.ResultsPrimary CPAP failure was found in 23% of patients who were more obese (p = 0.018), had worse lung function, lower PO₂ (p = 0.023) and higher PCO₂ while awake (p < 0.001), and more sleep time with an SpO₂ < 90% (CT90%) (p < 0.001) compared to those who responded to CPAP. In multivariate analysis, PCO₂ while awake [odds ratio (OR) 29.5, confidence interval (CI) 2.22–391, p = 0.010] and CT90% (OR 1.06, CI 1.01–1.11, p = 0.017) independently predicted CPAP failure after adjustments for covariates. The BiPAP therapy was well tolerated and effectively alleviated hypercapnia in all patients with primary CPAP failure.ConclusionsDaytime hypercapnia and nocturnal hypoxia are independent predictors of early CPAP failure in patients with the OSA–COPD overlap syndrome.     

BiPAP in acute respiratory failure due to myasthenic crisis may prevent intubation

Noninvasive mechanical ventilation using bilevel positive pressure ventilation (BiPAP) has not been studied in acute respiratory failure caused by MG. Eleven episodes in nine patients were initially managed with BiPAP, and endotracheal intubation was avoided in seven of these trials. Presence of hypercapnia (PaCO2 greater than 50 mm Hg) at onset predicted BiPAP failure and subsequent intubation. Results of this preliminary study suggest that a trial of BiPAP may prevent intubation in patients with myasthenic crisis without overt hypercapnia.     

Wheelchair economy class syndrome in amyotrophic lateral sclerosis

A wheelchair-bound 61-year-old diabetic man with amyotrophic lateral sclerosis (ALS) developed sudden respiratory failure. Specific findings for hypoxemia and hypocapnia were incompatible with type II respiratory failure seen in the terminal stages of ALS. 'Economy class syndrome' was diagnosed, with massive thrombosis in the pulmonary arteries and deep vein thrombosis. This case offers a warning for long-term wheelchair users, particularly hypoxemic ALS patients, regarding the risks of treatable pulmonary thromboembolism.