中国急诊科无创正压通气应用现状调查

A survey of the practice of non-invasive positive pressure ventilation in emergency department in China

目的初步了解无创无创正压通气（ non-invasive positive pressure ventilation, NPPV或NIPPV）在我国医院急诊科的应用现状。方法选取国内医院急诊科进行问卷调查，并对结果进行统计分析。结果317家医院急诊科中，150家（47．3％）配备无创呼吸机，其中三级医院144家，二级医院6家。NPPV应用最多的前五位情况分别是：慢性阻塞性肺疾病急性加重期（ acute exacerbation of chronic obstructive pulmonary diseases, AECOPD ）（29．7％），急性心源性肺水肿（23．2％），撤机前的序贯治疗（11．2％），急性呼吸窘迫综合征（ acute respiratory distress syndrome,ARDS ）（9．0％），拔管后失败的补救治疗（8．7％。双水平气道正压（ bi-level positive airway pressure, BiPAP ）S／T模式为最常应用模式（51．8％），其次是持续气道正压（ continuous positive airway pressure, CPAP ）模式（30．3％）和BiPAP（S）模式（12．5％。在NPPV连接装置的选择方面，口鼻面罩（73．7％）和鼻罩（24．2％）最为常用。NPPV未能被充分应用主要原因依次为：操作者未得到充分培训（36．8％），医生缺乏相关认识（22．9％），医疗人员配备不足（21．1％）和患者依从性差（11．0％oNPPV应用失败的主要的原因有：患者耐受性差（31．5％），参数设置不合适（25．6％），连接装置贴合不佳（17．8％），气道分泌物较多（14．7％）和意识状态受损（10．4％o结论在国内急诊领域，NPPV最主要应用于AECOPD和急性心源性肺水肿的治疗。硬件资源配备不均衡、人员知识缺乏和人力资源不足等问题是制约NPPV在急诊领域应用的重要因素。

Objective To investigate the application of non-invasive positive pressure ventilation in emergency department in China. Methods A questionnaire survey was carried out in the emergency department in China, then the results were analyzed. Results Out of the 317 hospitals, non-invasive ventilators were available in the emergency department in 150 clinics （47.3%）. Among them, 144 clinics were the tertiary hospitals, and 6 clinics were the secondary hospitals. The leading five causes for NPPV were as follows： acute exacerbation of chronic obstructive pulmonary diseases （AECOPD） （29.7%）, acute cardiogenic pulmonary edema （23.2%）, ventilator weaning （11.2%）, acute respiratory distress syndrome （ARDS） （9.0%）,and extubation failure （8.7%）. The bi-level positive airway pressure （BiPAP） S/T was the most commonly used ventilation mode （51.8%）, followed by the continuous positive airway pressure （CPAP）（30.3%） and BiPAP （S）（12.5%）. The oronasal mask （73.7%） and the nasal mask （24.2%） were the most favorable interfaces for NPPV. The reasons for NPPV underusing mainly included insufficient training （36.8%）, lacking of related knowledge （22.9%）, medical teaching staff shortage （21.1%） and poor compliance of patients （11.0%）. The main causes of the failure of NPPV were as follows： poor tolerance （31.5%）, irrational parameters setting （25.6%）, unfitness of interface （17.8%）, airway secretions （14.7%）, and disorders of consciousness （10.4%）. Conclusions In China, the types of patients most commonly treated with NPPV in the emergency department are those with AECOPD and acute cardiogenic pulmonary edema. Barriers to popularize the use of NPPV in the emergency department include availability of equipment, physician with familiarity in operating the NPPV, and human resources required for NPPV.