支气管哮喘和慢性阻塞性肺疾病所致呼吸衰竭的机械通气治疗进展

Advances in mechanical ventilation onrespiratoryfailure as a result of chronic obstructive pulmonary disease and bronchial asthma

历经多年发展,机械通气的理论和技术均已取得长足进步,无创机械通气的临床适应证不断扩大,有创机械通气则在病情危重、痰液引流不畅、无创机械通气治疗效果不佳的患者中发挥着重要作用。慢性气道疾病是导致呼吸衰竭的主要原因,慢性阻塞性肺疾病(COPD)是导致呼吸衰竭最常见的慢性疾病之一,而支气管哮喘的发病率近年呈现上升趋势,故本文主要围绕这两种疾病所致呼吸衰竭的机械通气治疗进行讨论。COPD所致呼吸衰竭以Ⅱ型呼衰为主,在急性加重期和稳定期均可出现,机械通气是常用治疗手段之一;支气管哮喘重度急性发作并发呼吸衰竭是支气管哮喘诊治中的急症,机械通气的首要目标是使患者达到充足的氧合及通气,最大程度减少过度充气。在临床工作中,对于能够配合无创机械通气的患者,早期无创机械通气可取得良好疗效,可避免气管插管,减少有创机械通气的实施,但对于严密观察下仍未在短期内获得缓解的患者,则应尽早建立人工气道,进行有创通气治疗。

Over years,great strides have been made in theories and practices of mechanical ventilation.The indications of non-invasive ventilation have been increasing,while invasive ventilation has been playing a vital role in patients who are critically ill with inadequate drainage of sputum and fail to benefit from non-invasive ventilation.Chronic diseases,including chronic obstructive pulmonary disease（COPD）,one of the most common chronic diseases,and bronchial asthma,the incidence of which is ascending recent years,are main causes for respiratory failure.Accordingly,we focus in the present paper on discussion and elaboration of respiratory failure as a result of COPD and bronchial asthma.Type II respiratory failure is the major type of respiratory failure induced by COPD,both in acute exacerbation and stable stage,and mechanical ventilation is one of the most common treatments.Severe acute bronchial asthma complicated with respiratory failure is an emergency.In this situation,primary goal of mechanical ventilation is to make an efficient oxygenation and ventilation of patients,and to avoid hyperinflation to the utmost.For patients who are able to cooperate,non-invasive ventilation in early stage may be beneficial,avoiding tracheal intubation and application of invasive ventilation.But in those who can not achieve remission in a short term,an artificial airway should be established for invasive ventilation as soon as possible.