常见呼吸系统疾病气管插管机械通气指征

Indications for mechanical ventilation in patients with common respiratory diseases

机械通气是治疗各种类型严重呼吸衰竭的有效手段。掌握机械通气指征,及时气管插管是提高严重呼吸衰竭机械通气治疗成功率的关键。各种疾病导致呼吸衰竭的气管插管指征有所不同。具备呼吸停止或呼吸微弱、意识障碍、血流动力学不稳定、严重缺氧、严重酸中毒、严重呼吸肌疲劳等条件之一是呼吸衰竭患者气管插管机械通气的通常指征。对于呼吸衰竭较严重而又一时无法确认是否行气管插管机械通气时,在严密观察下可以试行非机械通气治疗或无创正压通气。对治疗1～2 h病情无改善或加重者,则应及时气管插管机械通气。ARDS患者行无创正压通气效果欠佳,应及时气管插管机械通气。

Mechanical ventilation is effective for the treatment of severe respiratory failure. It is important to use the precise indications for mechanical ventilation. Endotracheal intubation is indicated in different situations of respiratory failure. Respiratory failure induced by respiratory arrest or respiratory weakness, disturbance of consciousness, hemodynamic instability, severe hypoxia, severe acidosis, and severe respiratory muscle fatigue, are general indications for mechanical ventilation using endotracheal intubation. Non-mechanical ventilation or noninvasive positive pressure ventilation for 1 to 2 hours should be applied with close monitoring in patients without definite indications. Further mechanical ventilation is required in patients without improvement after subsequent evaluation. Moreover, noninvasive positive pressure ventilation is inadequate for patients with ARDS, thus intubated mechanical ventilation is necessary in this situation.