摘要
根据现有指南意见,无创通气治疗肺性脑病是禁忌的,主要是因为患者意识障碍,呼吸机耐受性差,以及由于缺乏气道保护,误吸风险较高。尽管有创通气是治疗此类患者的金标准,但在治疗高碳酸性呼吸衰竭方面,尚无有效数据表明无创与有创通气究竟孰优孰劣。实际上,在无创通气治疗高碳酸性呼吸衰竭的随机对照试验中,神志改变的患者是被排除在外的。近来多个研究表明,对于高选择性的肺性脑病患者,若无禁忌、治疗团队经验丰富、能够进行密切监护和紧急气管插管,初始是可以谨慎尝试无创通气治疗的。本综述将讨论肺性脑病的病理生理学、临床特点以及无创通气代替有创通气,作为肺性脑病一线治疗措施方面的一些问题。
According to the classical international guidelines, noninvasive positive pressure ventilation(NPPV) is contraindicated in pulmonary encephalopathy due to the poor compliance to ventilator treatment of confused/agitated patients and the risk of aspirative pneumonia related to lack of airways protection. As a matter of fact, conventional mechanical ventilation has been recommended as "golden standard" in these patients. However, up to now there are not controlled data that have demonstrated in pulmonary encephalopathy the advantage of conventional mechanical ventilation vs non- invasive ventilation. In fact, patients with altered mental status have been systematically excluded from the randomised and controlled trials performed with non-invasive ventilation in hypercapnic acute respiratory failure. Recent studies have clearly demonstrated that an initial cautious NPPV trial in selected pulmonary encephalopathy patients may be attempt as long as there are no other contraindications and the technique is provided by experienced caregivers in a closely monitored setting where emergency tracheal intubation is always readily available. The purpose of this review is to report the physiologic rationale, the clinical feasibility and the still open questions about the careful use of noninvasive positive pressure ventilation in pulmonary encephalopathy as first-line ventilatory strategy in place of conventional mechanical ventilation via endotracheal intubation.
出处
《国际呼吸杂志》
2018年第2期156-160,共5页
International Journal of Respiration
关键词
无创正压通气
肺性脑病
慢性阻塞性肺疾病
呼吸衰竭
obstructive pulmonary Noninvasive positive pressure ventilation
Pulmonary encephalopathy
Chronic disease
Respiratory failure