• 沈陽軍區(qū)總醫(yī)院呼吸科(遼寧沈陽 110016);

目的  探討使用雙水平氣道正壓通氣(BiPAP)無創(chuàng)呼吸機對需長期輔助機械通氣的患者進(jìn)行有創(chuàng)機械通氣的可行性。方法  選擇2004年6月~2007年11月,因呼吸衰竭入住呼吸ICU,經(jīng)面罩機械通氣等方法撤機失敗或不能進(jìn)行面罩機械通氣的11例患者,給予氣管切開,更換BiPAP無創(chuàng)呼吸機行有創(chuàng)機械通氣,觀察改用無創(chuàng)呼吸機前后動脈血氣、住院時間、出院(或達(dá)到出院標(biāo)準(zhǔn))后存活時間等指標(biāo)。結(jié)果  無創(chuàng)通氣吸氣壓力設(shè)定為16~26 cm H2O,平均21.3 cm H2O,呼氣壓力4 cm H2O,呼吸頻率16次/min?;颊叩钠骄≡海ɑ蜻_(dá)到出院標(biāo)準(zhǔn))時間為(91.5±50.2)d,改為BiPAP呼吸機后平均住院(或達(dá)到出院標(biāo)準(zhǔn))時間為(23.5±12.2)d。出院(或達(dá)到出院標(biāo)準(zhǔn))后平均存活時間為(353.1±296.5)d,截至隨訪結(jié)束(2008年1月13日)有4例患者仍存活。BiPAP呼吸機使用前后動脈血pH、PaCO2、PaO2及SaO2均無顯著差異(P均 gt;0.05)。結(jié)論  對于臨床穩(wěn)定、仍需長期機械通氣的呼吸衰竭患者,使用BiPAP無創(chuàng)呼吸機通過氣管切開行有創(chuàng)機械通氣是可選擇的方法。

引用本文: 馬壯,史亮,槐永軍,謝華,林育紅,劉蕾. 雙水平氣道正壓通氣無創(chuàng)呼吸機進(jìn)行有創(chuàng)機械通氣的臨床研究. 中國呼吸與危重監(jiān)護(hù)雜志, 2008, 08(3): 187-189. doi: 復(fù)制

1. O’Donohue WJ Jr,Giovannoni RM,Goldberg AI,et al.Long-term mechanical ventilation.Guidelines for management in the home and at alternate community sites.Chest,1986,90(1 Suppl):1S-37S.
2. Farre R,Lloyd-Owen SJ,Ambrosino N,et al.Quality control of equipment in home mechanical ventilation:a European survey.Eur Respir J,2005,26:86-94.
3. Rady M,Johnson DJ.Hospital discharge to care facility:a patient-centered outcome for the evaluation of intensive care for octogenarians.Chest,2004,126:1583-1591.
4. 曾祥毅,王小平,張瓊,等.雙水平無創(chuàng)正壓通氣對急性肺損傷的治療價值.中國呼吸與危重監(jiān)護(hù)雜志,2006,5:432-434.
5. 向平超,楊珺楠,郭偉安,等.無創(chuàng)正壓通氣救治慢性阻塞性肺疾病并重度呼吸衰竭的臨床探討.中國呼吸與危重監(jiān)護(hù)雜志,2006,5:16-18.
6. Lewarski JS.Long-term care of the patient with a tracheostomy.Respir Care,2005,50:534-537.
7. Heffner JE,Hess D.Tracheostomy management in the chronically ventilated patient.Clin Chest Med,2001,22:55-69.
8. MacIntyre NR,Epstein SK,Carson S,et al.Management of patients requiring prolonged mechanical ventilation:report of a NAMDRC consensus conference.Chest,2005,128:3937-3954.
9. Griffiths J,Barber VS,Morgan L,et al.Systematic review and meta-analysis of studiesof the timing of tracheostomy in adult patients undergoing artificial ventilation.BMJ,2005,330:1243.
  1. 1. O’Donohue WJ Jr,Giovannoni RM,Goldberg AI,et al.Long-term mechanical ventilation.Guidelines for management in the home and at alternate community sites.Chest,1986,90(1 Suppl):1S-37S.
  2. 2. Farre R,Lloyd-Owen SJ,Ambrosino N,et al.Quality control of equipment in home mechanical ventilation:a European survey.Eur Respir J,2005,26:86-94.
  3. 3. Rady M,Johnson DJ.Hospital discharge to care facility:a patient-centered outcome for the evaluation of intensive care for octogenarians.Chest,2004,126:1583-1591.
  4. 4. 曾祥毅,王小平,張瓊,等.雙水平無創(chuàng)正壓通氣對急性肺損傷的治療價值.中國呼吸與危重監(jiān)護(hù)雜志,2006,5:432-434.
  5. 5. 向平超,楊珺楠,郭偉安,等.無創(chuàng)正壓通氣救治慢性阻塞性肺疾病并重度呼吸衰竭的臨床探討.中國呼吸與危重監(jiān)護(hù)雜志,2006,5:16-18.
  6. 6. Lewarski JS.Long-term care of the patient with a tracheostomy.Respir Care,2005,50:534-537.
  7. 7. Heffner JE,Hess D.Tracheostomy management in the chronically ventilated patient.Clin Chest Med,2001,22:55-69.
  8. 8. MacIntyre NR,Epstein SK,Carson S,et al.Management of patients requiring prolonged mechanical ventilation:report of a NAMDRC consensus conference.Chest,2005,128:3937-3954.
  9. 9. Griffiths J,Barber VS,Morgan L,et al.Systematic review and meta-analysis of studiesof the timing of tracheostomy in adult patients undergoing artificial ventilation.BMJ,2005,330:1243.
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