老年呼吸衰竭患者无创通气首次应用失败原因分析

Analysis of causes of failure of primary noninvasive ventilation on elderly patients with respiratory failure

目的探讨多种因素对老年呼吸衰竭患者首次应用无创正压机械通气(NIPPV)的影响。方法对62例老年呼吸衰竭NIPPV首次应用失败的病例进行分析。结果 50例(81%)应用后效果不佳或病情恶化,其中32例(52%)改用气管插管行有创通气。12例(19%)因恐惧或不能耐受而放弃NIPPV。结论 NIPPV首次应用失败的原因主要是对应用指征的把握不准确,患者病情过重或干预时机过晚;其次是面罩选择不合适以及医护人员与患者及家属缺乏有效的沟通。

Objective To discuss the effect of primary NIPPV on elderly patients with respiratory failure. Methods The causes of 62 elderly patients with respiratory failure failed on primary NIPPV were analyzed. Results There were 50 cases （ 81% ） with poor cur- ative effect or deterioration after the primary NIPPV, 32 cases of which were then changed to given invasive ventilation （52%）. 12 pa- tients （ 19% ） gave up NIPPV due to fear or intolerance. Conclusion The failure of first-time NIPPV is attributable mainly to the inaccu- rate performance of applied indication, the seriousness of patients＇ illness or delayed intervention, and it is also due to the mask unsuitable for patients and the lack of effective communication between medical staffs and patients and their families.