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Clinical characteristics and outcomes associated with nasal intermittent mandatory ventilation in acute pediatric respiratory failure 被引量:1
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作者 Billy C Wang Theodore Pei +4 位作者 Cheryl B Lin Rong Guo David Elashoff James A Lin Carol Pineda 《World Journal of Critical Care Medicine》 2018年第4期46-51,共6页
AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric i... AIM To characterize the clinical course and outcomes of nasal intermittent mandatory ventilation(NIMV) use in acute pediatric respiratory failure.METHODS We identified all patients treated with NIMV in the pediatric intensive care unit(PICU) or inpatient general pediatrics between January 2013 and December 2015 at two academic centers.Patients who utilized NIMV with other modes of noninvasive ventilation during the same admission were included.Data included demographics,vital signs on admission and prior to initiation of NIMV,pediatric risk of mortality Ⅲ(PRIsM-Ⅲ) scores,complications,respiratory support characteristics,PICU and hospital length of stays,duration of respiratory support,and complications.Patients who did not require escalation to mechanical ventilation were defined as NIMV responders;those who required escalation to mechanical ventilation(MV) were defined as NIMV nonresponders.NIMV responders were compared to NIMV non-responders.RESULTS Forty-two patients met study criteria.six(14%) failed treatment and required MV.The majority of the patients(74%) had a primary diagnosis of bronchiolitis.The median age of these 42 patients was 4 mo(range 0.5-28.1 mo,IQR 7,P = 0.69).No significant difference was measured in other baseline demographics and vitals on initiation of NIMV;these included age,temperature,respiratory rate,O2 saturation,heart rate,systolic blood pressure,diastolic blood pressure,and PRIsM-Ⅲ scores.The duration of NIMV was shorter in the NIMV nonresponder vs NIMV responder group(6.5 h vs 65 h,P < 0.0005).Otherwise,NIMV failure was not associated with significant differences in PICU length of stay(LOs),hospital LOs,or total duration of respiratory support.No patients had aspiration pneumonia,pneumothorax,or skin breakdown.CONCLUSION Most of our patients responded to NIMV.NIMV failure is not associated with differences in hospital LOs,PICU LOs,or duration of respiratory support. 展开更多
关键词 Continuous POSITIVE AIRWAY PRESSURE Pediatric Noninvasive POSITIVE PRESSURE ventilation NASAL INTERMITTENT MANDATORY ventilation High flow NASAL cannula acute respiratory failure Bilevel POSITIVE AIRWAY PRESSURE
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Application of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU 被引量:3
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作者 Xiu-Min Zhang Hai-Yan Wu Xiao-Juan Sun 《Journal of Hainan Medical University》 2017年第4期109-111,共3页
Objective:To observe the application effect of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU.Methods:A total of 80 patients with acute heart failure merged with... Objective:To observe the application effect of non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure in ICU.Methods:A total of 80 patients with acute heart failure merged with respiratory failure who were admitted in ICU from January, 2015 to January, 2016 were included in the study and randomized into the observation group and the control group with 40 cases in each group. The patients in the two groups were given routine treatments after admission. On this basis, the patients in the observation group were given non-invasive ventilator. The patients in the control group were given continuous low flow oxygen inhalation. PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before and after treatment between the two groups were compared. The serum NT-pro BNP and cTnI levels before treatment, 24 h and 48 h after treatment in the two groups were compared.Results:The comparison of PaO2, pH, PaCO2, SaO2, and PaO2/FiO2 before treatment between the two groups was not statistically significant. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the two groups were significantly elevated, while PaCO2 was significantly reduced when compared with before treatment. PaO2, pH, SaO2, and PaO2/FiO2 after treatment in the observation group were significantly higher than those in the control group, while PaCO2 was significantly lower than that in the control group. The comparison of NT-pro BNP and cTnI levels before treatment between the two groups was not statistically significant. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the two groups were significantly elevated when compared with before treatment. NT-pro BNP and cTnI levels 12 h and 24 h after treatment in the observation group were significantly lower than those in the control group.Conclusions:Non-invasive ventilator in the treatment of acute heart failure merged with respiratory failure can effectively improve the ventilation function, reduce NT-pro BNP and cTnI levels, and is of great significance in enhancing the rescued effect. 展开更多
关键词 NON-INVASIVE VENTILATOR acute heart failure respiratory failure Blood gas index NT-pro BNP CTNI
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Application of fiberoptic bronchscopy in patients with acute exacerbations of chronic obstructive pulmonary disease during sequential weaning of invasive-noninvasive mechanical ventilation 被引量:17
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作者 Rong-rong Song Yan-ping Qiu +1 位作者 Yong-ju Chen Yong Ji 《World Journal of Emergency Medicine》 CAS 2012年第1期29-34,共6页
BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmon... BACKGROUND:Early withdrawal of invasive mechanical ventilation(IMV) followed by noninvasive MV(NIMV) is a new strategy for changing modes of treatment in patients with acute exacerbations of chronic obstructive pulmonary disease(AECOPD) with acute respiratory failure(ARF).Using pulmonary infection control window(PIC window) as the switch point for transferring from invasive to noninvasive MV,the time for early extubation can be more accurately judged,and therapy efficacy can be improved.This study aimed to prospectively investigate the clinical effectiveness of fiberoptic bronchscopy(FOB) in patients with AECOPD during sequential weaning of invasive-noninvasive MV.METHODS:Since July 2006 to January 2011,106 AECOPD patients with ARF were treated with comprehensive medication and IMV after hospitalization.Patients were randomly divided into two groups according to whether fiberoptic bronchoscope is used(group A,n=54) or not(group B,n=52) during sequential weaning from invasive to noninvasive MV.In group A,for sputum suction and bronchoalveolar lavage(BAL),a fiberoptic bronchoscope was put into the airway from the outside of an endotracheal tube,which was accompanied with uninterrupted use of a ventilator.After achieving PIC window,patients of both groups changed to NIMV mode,and weaned from ventilation.The following listed indices were used to compare between the groups after treatment:1) the occurrence time of PIC,the duration of MV,the length of ICU stay,the success rate of weaning from MV for the first time,the rate of reventilatJon and the occurrence rate of ventilator-associated pneumonia(VAP);2) the convenience and safety of FOB manipulation.The results were compared using Student's f test and the Chi-square test.RESULTS:The occurrence time of PIC was(5.01 ±1.49) d,(5.87±1.87) d in groups A and B,respectively(P<0.05);the duration of MV was(6.98±1.84) d,(8.69±2.41) d in groups A and B,respectively(P<0.01);the length of ICU stay was(9.25±1.84) d,(11.10±2.63) d in groups A and B,respectively(P<0.01);the success rate of weaning for the first time was 96.30%,76.92%in groups A and B,respectively(P<0.01);the rate of reventilation was 5.56%,19.23%in groups A and B,respectively(P<0.05);and the occurrence rate of VAP was 3.70%,23.07%in groups A and B,respectively(P<0.01).Moreover,it was easy and safe to manipulate FOB,and no side effect was observed.CONCLUSIONS:The application of FOB in patients with AECOPD during sequential weaning of invasive-noninvasive MV is effective in ICU.It can decrease the duration of MV and the length of ICU stay,increase the success rate from weaning MV for the first time,reduce the rate of reventilation and the occurrence rate of VAP.In addition,such a method is convenient and safe in patients of this kind. 展开更多
关键词 acute exacerbations of chronic obstructive pulmonary disease acute respiratory failure Mechanical ventilation Sequential weaning of invasive-noninvasive ventilation Fiberoptic bronchscopy Bronchoalveolar lavage Pulmonary infection control window Side effect Success rate
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Efficacy and safety of noninvasive positive pressure ventilation in the treatment of acute respiratory failure after cardiac surgery 被引量:11
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作者 ZHU Guang-fa WANG Di-jia +2 位作者 LIU Shuang JIA Ming JIA Shi-jie 《Chinese Medical Journal》 SCIE CAS CSCD 2013年第23期4463-4469,共7页
Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respirat... Background Although noninvasive positive pressure ventilation (NPPV) has been successfully used for various kinds of acute respiratory failure,the data are limited regarding its application in postoperative respiratory failure after cardiac surgery.Therefore,we conducted a prospective randomized control study in a university surgical intensive care unit to evaluate the efficacy and safety of NPPV in the treatment of acute respiratory failure after cardiac surgery,and explore the predicting factors of NPPV failure.Methods From September 2011 to November 2012 patients with acute respiratory failure after cardiac surgery who had indication for the use of NPPV were randomly divided into a NPPV treatment group (NPPV group) and the conventional treatment group (control group).The between-group differences in the patients' baseline characteristics,re-intubation rate,tracheotomy rate,ventilator associated pneumonia (VAP) incidence,in-hospital mortality,mechanical ventilation time after enrollment (MV time),intensive care unit (ICU) and postoperative hospital stays were compared.The factors that predict NPPV failure were analyzed.Results During the study period,a total of 139 patients who had acute respiratory failure after cardiac surgery were recorded,and 95 of them met the inclusion criteria,which included 59 males and 36 females with a mean age of (61.5±11.2) years.Forty-three patients underwent coronary artery bypass grafting (CABG),23 underwent valve surgery,13 underwent CABG+valve surgery,13 underwent major vascular surgery,and three underwent other surgeries.The NPPV group had 48 patients and the control group had 47 patients.In the NPPV group,the re-intubation rate was 18.8%,tracheotomy rate was 12.5%,VAP incidence was 0,and the in-hospital mortality was 18.8%,significantly lower than in the control group 80.9%,29.8%,17.0% and 38.3% respectively,P <0.05 or P <0.01.The MV time and ICU stay (expressed as the median (P25,P75)) were 18.0 (9.2,35.0) hours and 4.0 (2.0,5.0) days,which were significantly shorter than in the control group,96.0 (26.0,240.0) hours and 6.0 (4.0,9.0) days respectively,P <0.05 or P <0.01.The postoperative hospital stays of the two groups were similar.The univariate analysis showed that the NPPV success subgroup had more patients with acute lung injury (ALl) (17 vs.0,P=0.038),fewer patients with pneumonia (2 vs.7,P <0.001) and lower acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) scores (16.1±2.8 vs.21.8±3.2,P <0.001).Multivariate analysis showed that pneumonia (P=-0.027) and a high APACHE Ⅱ score >20 (P=-0.002) were the independent risk factors of NPPV failure.Conclusions We conclude that NPPV can be applied in selected patients with acute respiratory failure after cardiac surgery to reduce the need of re-intubation and improve clinical outcome as compared with conventional treatment.Pneumonia and a high APACHE Ⅱ score >20 might be the independent risk factors of NPPV failure in this group of patients. 展开更多
关键词 noninvasive positive pressure ventilation acute respiratory failure cardiac surgery intensive care medicine
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Non-invasive versus invasive mechanical ventilation for respiratory failure in severe acute respiratory syndrome 被引量:3
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作者 Loretta YC Yam Alfred YF Chan +3 位作者 Thomas MT Cheung Eva LH Tsui Jane CK Chan Vivian CW Wong 《Chinese Medical Journal》 SCIE CAS CSCD 2005年第17期1413-1421,共9页
Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical vent... Background Severe acute respiratory syndrome is frequently complicated by respiratory failure requiring ventilatory support.We aimed to compare the efficacy of non-invasive ventilation against invasive mechanical ventilation treating respiratory failure in this disease.Methods Retrospective analysis was conducted on all respiratory failure patients identified from the Hong Kong Hospital Authority Severe Acute Respiratory Syndrome Database.Intubation rate,mortality and secondary outcome of a hospital utilizing non-invasive ventilation under standard infection control conditions(NIV Hospita1)were compared against 13 hospitals using solely invasive ventilation(IMV Hospitals).Multiple logistic regression analyses with adjustments for confounding variables were performed to test for association between outcomes and hospital groups.Results Both hospital groups had comparable demographics and clinical profiles,but NIV Hospital(42 patients)had higher lactate dehydrogenase ratio and worse radiographic score on admission and ribavirin-corticosteroid commencement.Compared to IMV Hospitals(451 patients).NIV Hospital had lower adjusted odds ratios for intubation(0.36,95%C10.164-0.791,P=0.011)and death(0.235.95%C10.077-0.716,P=0.O 11),and improved earlier after pulsed steroid rescue.There were no instances of transmission of severe acute respiratory syndrome among health care workers due to the use of non-invasive ventilation.Conclusion Compared to invasive mechanical ventilation,non-invasive ventilation as initial ventilatory support for acute respiratory failure in the presence of severe acute respiratory syndrome appeared to be associated with reduced intubation need and mortality. 展开更多
关键词 acute respiratory failure infection control invasive mechanical ventilation non-invasive ventilation severe acute respiratory syndrome
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Noninvasive ventilation in trauma 被引量:3
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作者 Marcin K Karcz Peter J Papadakos 《World Journal of Critical Care Medicine》 2015年第1期47-54,共8页
Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange,... Trauma patients are a diverse population with heterogeneous needs for ventilatory support. This requirement depends mainly on the severity of their ventilatory dysfunction, degree of deterioration in gaseous exchange, any associated injuries, and the individual feasibility of potentially using a noninvasive ventilation approach. Noninvasive ventilation may reduce the need to intubate patients with traumarelated hypoxemia. It is well-known that these patientsare at increased risk to develop hypoxemic respiratory failure which may or may not be associated with hypercapnia. Hypoxemia in these patients is due to ventilation perfusion mismatching and right to left shunt because of lung contusion, atelectasis, an inability to clear secretions as well as pneumothorax and/or hemothorax, all of which are common in trauma patients. Noninvasive ventilation has been tried in these patients in order to avoid the complications related to endotracheal intubation, mainly ventilator-associated pneumonia. The potential usefulness of noninvasive ventilation in the ventilatory management of trauma patients, though reported in various studies, has not been sufficiently investigated on a large scale. According to the British Thoracic Society guidelines, the indications and efficacy of noninvasive ventilation treatment in respiratory distress induced by trauma have thus far been inconsistent and merely received a low grade recommendation. In this review paper, we analyse and compare the results of various studies in which noninvasive ventilation was applied and discuss the role and efficacy of this ventilator modality in trauma. 展开更多
关键词 acute respiratory DISTRESS syndrome NONINVASIVE ventilation PULMONARY CONTUSION respiratory failure TRAUMA
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无创机械通气联合呼吸训练在AECOPD合并呼吸衰竭患者中的应用评价
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作者 叶宁 罗淼 +1 位作者 秦燕 唐丽娟 《中国医学创新》 CAS 2024年第6期27-31,共5页
目的:探讨无创机械通气联合呼吸训练对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的效果。方法:前瞻性纳入2019年2月—2022年2月桂林医学院附属医院急诊科收治的AECOPD合并呼吸衰竭患者共67例,采用随机数字表法将患者分为两... 目的:探讨无创机械通气联合呼吸训练对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者的效果。方法:前瞻性纳入2019年2月—2022年2月桂林医学院附属医院急诊科收治的AECOPD合并呼吸衰竭患者共67例,采用随机数字表法将患者分为两组。对照组(n=33)接受间断无创机械通气治疗,观察组(n=34)在对照组基础上增加主动呼吸训练(包括上肢弹力带阻抗训练、缩唇腹式呼吸、呼吸训练器使用)。记录两组2 d内撤机成功率、不良反应发生率,比较两组氧合指数(OI)、动脉血二氧化碳分压(PaCO_(2))、改良版英国医学研究委员会(mMRC)呼吸困难问卷分级、呼吸频率(RR)、自主呼吸潮气量。结果:对照组2 d内撤机成功率为60.6%,观察组为82.4%,观察组的撤机成功率高于对照组(P<0.05);观察组咳痰乏力、呼吸疲劳发生率均低于对照组(P<0.05);与治疗前相比,两组患者治疗2 d后的OI和PaCO_(2)均有显著改善,差异均有统计学意义(P<0.05);治疗2 d后,观察组PaCO_(2)低于对照组(P<0.05),但两组OI比较,差异无统计学意义(P>0.05);与治疗前相比,两组患者治疗2 d后的mMRC呼吸困难问卷分级和RR均有明显下降,自主呼吸潮气量均有明显提升,差异均有统计学意义(P<0.05);治疗2 d后,两组mMRC呼吸困难问卷分级和RR比较,差异均无统计学意义(P>0.05),但观察组患者自主呼吸潮气量明显高于对照组(P<0.05)。结论:AECOPD合并呼吸衰竭患者进行无创机械通气联合呼吸训练,能有效改善呼吸肌疲劳,增加肺通气,提高撤机成功率。 展开更多
关键词 无创机械通气 呼吸训练 慢性阻塞性肺疾病急性加重期 呼吸衰竭
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由乐果导致的重度急性有机磷中毒合并脓毒性休克的治疗体会
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作者 张艳芳 姚垚 +3 位作者 邓莹 熊穗 马力 陈国兵 《中国中西医结合急救杂志》 CAS CSCD 2024年第1期100-102,共3页
目的描述1例重度急性有机磷中毒(AOPP)合并复发性呼吸衰竭、中间综合征(IMS)、多器官功能障碍综合征(MODS)和脓毒症的诊断、治疗及临床病程。方法云南省第一人民医院内科重症监护病房(MICU)于2021年5月8日收治了1例自服农药乐果AOPP患者... 目的描述1例重度急性有机磷中毒(AOPP)合并复发性呼吸衰竭、中间综合征(IMS)、多器官功能障碍综合征(MODS)和脓毒症的诊断、治疗及临床病程。方法云南省第一人民医院内科重症监护病房(MICU)于2021年5月8日收治了1例自服农药乐果AOPP患者,经过29d的治疗痊愈出院。介绍临床诊治过程。结果患者男性,78岁,因自服农药乐果导致AOPP。入院后迅速出现呼吸衰竭,经紧急气管插管接呼吸机辅助呼吸,并进行一系列针对性治疗,包括应用复能剂碘解磷定、阿托品和山若碱,以及抗菌药物、维持水电解质和酸碱平衡等。在治疗过程中,患者病情经历了多次反复,如脓毒症发作、胆碱酯酶(ChE)水平大幅波动、多重耐药菌感染、呼吸衰竭反复出现等情况。最终,经过29d的治疗,患者成功脱离呼吸机,各器官功能恢复正常出院。结论通过对该病例的分析,提示在AOPP救治过程中需密切关注调整药物剂量,防治感染、脓毒性休克和呼吸机相关性肺炎(VAP)的发生,并及时心理评估和干预的重要性。 展开更多
关键词 急性有机磷中毒 呼吸衰竭 中间综合征 脓毒症 呼吸机相关性肺炎 感染控制
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呼吸机辅助急诊治疗老年急性呼吸衰竭的效果
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作者 徐万忠 白艳丽 《中外医药研究》 2024年第1期63-65,共3页
目的:分析呼吸机辅助急诊治疗老年急性呼吸衰竭的作用。方法:选取2021年1月—2022年12月固原市人民医院收治的老年急性呼吸衰竭患者60例为研究对象,按随机数字分配表法分为对照组与观察组,各30例。对照组采用常规临床急诊治疗,观察组在... 目的:分析呼吸机辅助急诊治疗老年急性呼吸衰竭的作用。方法:选取2021年1月—2022年12月固原市人民医院收治的老年急性呼吸衰竭患者60例为研究对象,按随机数字分配表法分为对照组与观察组,各30例。对照组采用常规临床急诊治疗,观察组在对照组基础上予以呼吸机辅助治疗。比较两组临床疗效、生命体征指征、血气指标。结果:观察组临床疗效有效率高于对照组,差异有统计学意义(P=0.038);治疗后,两组心率、呼吸频率、舒张压、收缩压均降低,观察组低于对照组,差异有统计学意义(P<0.001);治疗后,两组血氧分压、动脉血二氧化碳分压、血氧饱和度水平均优于治疗前,观察组优于对照组,差异有统计学意义(P<0.001)。结论:在老年急性呼吸衰竭患者急诊治疗中予以呼吸机辅助治疗,可提高临床疗效,改善患者各项生命体征及血气指标,临床应用价值较高。 展开更多
关键词 急性呼吸衰竭 老年患者 急诊治疗 呼吸机
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氧疗联合俯卧位呼吸治疗急性呼吸衰竭的临床效果
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作者 刘天荣 夏青 崔红 《医药前沿》 2024年第29期25-27,共3页
目的:分析急性呼吸衰竭(ARF)应用氧疗联合俯卧位呼吸治疗的效果。方法:选取2022年7月—2023年12月新疆医科大学第六附属医院收治的21例清醒急性呼吸衰竭患者为研究对象。比较分析不同时间患者的心电监测指标和动脉血气指标。结果:初始... 目的:分析急性呼吸衰竭(ARF)应用氧疗联合俯卧位呼吸治疗的效果。方法:选取2022年7月—2023年12月新疆医科大学第六附属医院收治的21例清醒急性呼吸衰竭患者为研究对象。比较分析不同时间患者的心电监测指标和动脉血气指标。结果:初始位、俯卧位0.5h、俯卧位1h患者的心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、氧灌注指数(PI)水平比较,差异均无统计学意义(P>0.05);俯卧位0.5h时患者的血氧饱和度(SpO_(2))与初始位比较,差异无统计学意义(P>0.05);俯卧位1h患者的SpO_(2)与初始位比较,差异有统计学意义(Ρ<0.05);初始位与俯卧位1h时患者的pH值、二氧化碳分压(PaCO_(2))水平比较,差异无统计学意义(P>0.05);但动脉血氧分压(PaO_(2))、氧合指数水平比较,差异有统计学意义(Ρ<0.05)。21例患者中无患者发生血液动力学异常情况。结论:氧疗联合俯卧位呼吸治疗ARF患者疗效显著,可以改善患者氧合状况,可作为基层医疗机构和急诊进行急救的一种方法。 展开更多
关键词 急性呼吸衰竭 俯卧位呼吸 氧疗 血氧饱和度 灌注指数 氧合指数
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俯卧位通气用于急性呼吸衰竭患者中的效果分析
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作者 陈晓莉 《中外医药研究》 2024年第1期33-35,共3页
目的:分析俯卧位通气用于急性呼吸衰竭患者中的效果。方法:选取2022年11月—2023年3月济宁市第一人民医院收治的急性呼吸衰竭患者64例为研究对象,按随机数字表法分为对照组与观察组,各32例。两组均给予通气治疗,对照组患者取水平卧位,... 目的:分析俯卧位通气用于急性呼吸衰竭患者中的效果。方法:选取2022年11月—2023年3月济宁市第一人民医院收治的急性呼吸衰竭患者64例为研究对象,按随机数字表法分为对照组与观察组,各32例。两组均给予通气治疗,对照组患者取水平卧位,观察组患者取俯卧位。比较两组动脉血氧分压(PaO_(2))/吸入氧浓度(FiO_(2))、PaO_(2)、呼吸(R)、心率(HR)、动脉血二氧化碳分压(PaCO_(2))、呼吸频率(RR)、潮气量(VT)及动脉血氧饱和度(SaO_(2))指标。结果:通气前,两组PaO_(2)/FiO_(2)、PaO_(2)、R、HR、PaCO_(2)、RR、VT及SaO_(2)比较,差异无统计学意义(P>0.05);通气1、2 h,两组PaO_(2)/FiO_(2)、PaO_(2)、R、HR、VT及SaO_(2)均高于通气前,PaCO_(2)、RR均低于通气前,差异有统计学意义(P<0.05);通气1、2h,观察组PaO_(2)/FiO_(2)、VT高于对照组,PaCO_(2)、RR均低于对照组,差异有统计学意义(P<0.05);通气1 h,观察组R、SaO_(2)高于对照组,通气2 h,观察组PaO_(2)高于对照组,差异有统计学意义(P<0.05);通气1 h,两组PaO_(2)、HR,通气2 h,两组R、HR、SaO_(2)比较,差异无统计学意义(P>0.05)。结论:给予急性呼吸衰竭患者俯卧位通气能有效调节临床相关指标,具有明显优势。 展开更多
关键词 俯卧位通气 急性呼吸衰竭 血气分析
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经鼻高流量氧疗对比无创正压通气在急性心力衰竭伴Ⅰ型呼吸衰竭患者中的应用价值 被引量:2
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作者 武亚梅 王晶 唐娜 《中国心血管病研究》 CAS 2024年第2期131-135,共5页
目的研究经鼻高流量氧疗(high flow nasal cannula oxygen therapy,HFNC)对比无创正压通气(noninvasive positive pressure ventilation,NPPV)在急性心力衰竭(acute heart failure,AHF)伴Ⅰ型呼吸衰竭患者的治疗效果。方法选择2022年1月... 目的研究经鼻高流量氧疗(high flow nasal cannula oxygen therapy,HFNC)对比无创正压通气(noninvasive positive pressure ventilation,NPPV)在急性心力衰竭(acute heart failure,AHF)伴Ⅰ型呼吸衰竭患者的治疗效果。方法选择2022年1月至2022年12月首都医科大学宣武医院急诊科收治的94例AHF伴Ⅰ型呼吸衰竭患者,随机分为观察组48例和对照组46例。两组患者均给予常规扩血管、利尿等治疗,对照组给予NPPV治疗,观察组给予HFNC治疗,分别比较两组患者治疗前、治疗24 h后的呼吸频率、心率、血清N末端B型利钠肽原(NT-proBNP)、动脉氧分压(PaO_(2))和动脉二氧化碳分压(PaCO_(2))的变化情况及2组比较的区别,应用调查问卷评估两组患者治疗舒适度的区别。随访28 d,分别比较两组患者治疗后误吸、胃胀气等并发症发生率、气管插管率及病死率。结果观察组与对照组治疗后的呼吸频率、心率和NT-proBNP较前明显降低(P均<0.05),PaO_(2)较前升高(P均<0.05),PaCO_(2)较前升高(P<0.05),但仍在正常范围内;观察组治疗后呼吸频率是(23.77±2.36)次/min、心率为(89.17±5.80)次/min、NT-proBNP为[13631.00(9997.25,16328.00)]pg/ml、PaO_(2)为(66.87±2.78)mmHg和PaCO_(2)为(37.06±2.56)mmHg,与对照组的(23.33±2.81)次/min、(87.69±5.02)次/min、[12517.00(9836.75,17742.00)]pg/ml、(67.74±2.67)mmHg和(37.07±1.93)mm Hg比较无统计学差别(均P>0.05);调查问卷显示,观察组舒适度评分大于对照组[(3.35±0.69)分比(2.76±0.77)分,P=0.001],并发症发生率小于对照组(10.41%比28.26%,P=0.028),两组患者气管插管率(12.50%比10.86%)和病死率(10.41%比8.69%)比较无统计学差别(P>0.05)。结论HFNC和NPPV在AHF伴Ⅰ型呼吸衰竭患者中应用均具有较好的治疗效果,但HFNC并发症较较少,患者舒适程度更高。 展开更多
关键词 急性心力衰竭 Ⅰ型呼吸衰竭 经鼻高流量氧疗 无创正压通气
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HFNC与NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效观察
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作者 应琴丽 周世彬 +3 位作者 李焕根 魏思灿 黄鸣恋 陈伟文 《北京医学》 CAS 2024年第3期204-209,共6页
目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)与无创正压通气(non-invasive positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并... 目的探讨经鼻高流量氧疗(high-flow nasal cannula,HFNC)与无创正压通气(non-invasive positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者的临床疗效。方法选取2021年1月至2023年1月福建医科大学附属泉州第一医院重症医学科AECOPD患者146例,根据治疗方法不同分为NIPPV组(n=47)、HFNC组(n=49)和常规治疗组(n=50)。NIPPV组采用NIPPV治疗,HFNC组采用HFNC治疗,常规治疗组采用常规氧疗和抗感染治疗。比较3组循环指标、血气指标、呼吸支持时间、气道护理次数及舒适(general comfort questionnaire,GCQ)评分。结果146例患者中男76例、女70例,年龄56~77岁,平均(66.2±5.3)岁。与治疗前相比,治疗2 h和治疗24 h时,3组呼吸频率(respiratory rate,RR)和HR较低;治疗6 h和治疗24 h时,HFNC组RR、HR均低于NIPPV组和常规治疗组,差异有统计学意义(P<0.05)。与治疗前相比,治疗7 d后3组PaO_(2)均升高、PaCO_(2)均降低;治疗7 d后,与NIPPV组和常规组相比,HFNC组PaO_(2)较高、PaCO_(2)较低,差异有统计学意义(P<0.05)。3组呼吸支持时间和气道护理次数的差异有统计学意义(P<0.05),其中NIPPV组呼吸支持时间较短,HFNC组气道护理次数较少。结论HFNC可以改善AECOPD合并Ⅱ型呼衰患者的部分循环指标和血气指标,患者舒适度更好,但呼吸支持时间较长。 展开更多
关键词 慢性阻塞性肺疾病急性加重期 呼吸衰竭 经鼻高流量氧疗 无创正压通气
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NLR、IRF1与急性呼吸衰竭患者机械通气撤机失败的相关性研究
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作者 努力满·赛麦特 张文玲 +2 位作者 阿里亚·艾海提 玛依拉·阿扎提 麦丽开·艾海提 《四川医学》 CAS 2024年第11期1187-1193,共7页
目的探讨中性粒细胞/淋巴细胞比值(NLR)、干扰素调节因子1(IRF1)与急性呼吸衰竭(ARF)患者机械通气撤机失败的相关性。方法前瞻性选取2022年9月至2023年9月我院收治的120例重症ARF患者为研究对象,根据患者有创机械通气撤机结局分为撤机... 目的探讨中性粒细胞/淋巴细胞比值(NLR)、干扰素调节因子1(IRF1)与急性呼吸衰竭(ARF)患者机械通气撤机失败的相关性。方法前瞻性选取2022年9月至2023年9月我院收治的120例重症ARF患者为研究对象,根据患者有创机械通气撤机结局分为撤机失败组与撤机成功组。比较两组通气前、通气24 h、通气48 h的NLR、IRF1水平,并分析NLR、IRF1与患者机械通气撤机失败的相关性,并评估两指标预测患者机械通气撤机失败的价值。结果120例患者中28例患者撤机失败(23.33%)。撤机失败组有创机械通气时间≥7 d占比高于撤机成功组(P<0.05);撤机失败组通气前、通气24 h、通气48 h的NLR、IRF1 mRNA水平均高于撤机成功组(P<0.05);且各时点的两指标与ARF患者机械通气撤机失败均呈正相关(r>0,P<0.05),通气48 h时r值最大。以通气48 h数据进行限制性立方样条模型(RCS)分析,NLR、IRF1与机械通气撤机失败的关联呈非线性J型剂量反应关系。Logistic回归分析,通气48 h的NLR、IRF1、有创机械通气时间≥7 d均是影响ARF患者机械通气撤机失败的相关因素(P<0.05),根据回归方程最佳截断值将患者分为低风险组和高风险组,高风险组第一次撤机期间相关并发症发生率高于低风险组(P<0.05);绘制受试者工作特征曲线图(ROC)显示,通气48 h的NLR、IRF1单独及联合预测ARF患者机械通气撤机失败的曲线下面积分别为0.776、0.937、0.952,均具有一定的预测价值,联合预测的效能相对较高。结论NLR、IRF1与ARF患者机械通气撤机失败密切相关,其机制主要涉及炎症反应,同时两指标在提示患者病情变化上有一定的辅助性作用,且NLR、IRF1对预测ARF患者机械通气撤机失败具有一定的价值。 展开更多
关键词 急性呼吸衰竭 有创机械通气 撤机失败 中性粒细胞/淋巴细胞比值 干扰素调节因子1
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无创呼吸机在急性呼吸衰竭患者治疗中的应用及临床有效性评价 被引量:1
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作者 沈章华 《中国医药指南》 2024年第6期89-91,95,共4页
目的分析无创呼吸机的治疗效果,研究该措施实施后急性呼吸衰竭患者的疗效情况。方法将2018年5月至2023年5月收治的急性呼吸衰竭患者作为研究对象,遵循随机对照原则,将共计入组的100例患者进行分组对比研究,每组均纳入50例样本。给予对... 目的分析无创呼吸机的治疗效果,研究该措施实施后急性呼吸衰竭患者的疗效情况。方法将2018年5月至2023年5月收治的急性呼吸衰竭患者作为研究对象,遵循随机对照原则,将共计入组的100例患者进行分组对比研究,每组均纳入50例样本。给予对照组患者常规治疗,给予研究组无创呼吸机治疗。分析两组治疗前后数据,并纳入统计学软件对比,指标包括:血气指标、肺功能、血常规指标、C-反应蛋白、并发症、治疗有效率。结果两组肺功能对比显示,对照组、研究组均得到有效改善,且后者的改善程度高于前者,P<0.05,对比有意义;研究组血气指标分析优于对照组(P<0.05);与对照组患者血常规指标对比显示,研究组数据较高,统计学差异分析有意义(P<0.05);对照组并发症总发生率高于研究组,治疗有效率低于研究组,上述指标差异均存在统计学对比意义(P<0.05)。结论无创呼吸机疗效及安全性高,可以帮助患者改善气道重塑、氧化应激及血气指标,对患者肺功能的提升具有促进作用。 展开更多
关键词 无创呼吸机 急性呼吸衰竭 血常规 C-反应蛋白 血气指标 肺功能
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无创正压机械通气治疗AECOPD合并呼吸衰竭的效果
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作者 刘成林 刘海洋 《中国卫生标准管理》 2024年第14期92-95,共4页
目的对比慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭(respiratory failure,RF)患者应用无创正压机械通气(noninvasive positive pressure ventilation,NPPV)与常规... 目的对比慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭(respiratory failure,RF)患者应用无创正压机械通气(noninvasive positive pressure ventilation,NPPV)与常规对症治疗在治疗效果之间的差异及2种治疗方式对血气指标、肺相关功能的影响。方法回顾性分析东台市人民医院2021年1月—2023年6月收治的82例AECOPD合并RF患者。按照治疗方法的差异分为常规组、NPPV组,各41例。对比2组患者肺功能情况、血气指标、生命体征指标、临床疗效和不良反应发生情况。结果NPPV组治疗后用力肺活量(forced vital capacity,FVC)、第1秒用力呼气容积(forced expiratory volume in the first second,FEV_(1))、第1秒用力呼气容积占用力肺活量的比例(forced expiratory volume in the first second/forced vital capacity,FEV_(1)/FVC)、动脉血氧分压(partial pressure of oxygen in arterial blood,PaO_(2))高于常规组,而动脉血二氧化碳分压(partial pressure of carbon dioxide in arterial blood,PaCO_(2))低于常规组(P<0.05);NPPV组治疗后的呼吸频率、心率、平均动脉压均低于常规组(P<0.05);NPPV组总有效率为95.12%,高于常规组的73.17%(P<0.05);NPPV组不良反应总发生率为7.32%,低于常规组的26.83%(P<0.05)。结论NPPV治疗能够让AECOPD合并RF患者的肺功能得以提高,临床治疗效果较好,改善其血氧方面的指标及预后。 展开更多
关键词 无创正压机械通气 呼吸衰竭 肺功能 血气指标 慢性阻塞性肺疾病急性加重期 疗效
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ICU急性呼吸衰竭患者外周血HCAR、DcR3、AQP-5水平与机械通气撤机结局的关系及价值分析
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作者 程亚娟 乔莉 《中国急救复苏与灾害医学杂志》 2024年第1期51-55,共5页
目的 探究重症监护室(ICU)急性呼吸衰竭患者外周血超敏C反应蛋白与白蛋白比值(HCAR)、诱骗受体3(DcR3)、水通道蛋白-5(AQP-5)水平与机械通气撤机结局的关系及临床价值。方法 选取连云港市第二人民医院2018年8月—2021年8月ICU急性呼吸... 目的 探究重症监护室(ICU)急性呼吸衰竭患者外周血超敏C反应蛋白与白蛋白比值(HCAR)、诱骗受体3(DcR3)、水通道蛋白-5(AQP-5)水平与机械通气撤机结局的关系及临床价值。方法 选取连云港市第二人民医院2018年8月—2021年8月ICU急性呼吸衰竭患者120例,均行机械通气治疗,在符合自主呼吸试验(SBT)指征且通过30 min SBT后撤机,根据撤机后48 h内是否再插管分为撤机成功组(87例)和撤机失败组(33例),撤机前采集外周血检测HCAR、DcR3、AQP-5水平,分析外周血HCAR、DcR3、AQP-5水平与撤机结局的关系及预测价值。结果 两组呼吸衰竭类型、合并器官功能障碍综合征(MODS)、肺部超声评分(LUS)、急性生理与慢性健康评价系统Ⅱ(APACHEⅡ)评分差异有统计学意义(P<0.05);撤机失败组外周血HCAR、DcR3高于撤机成功组,AQP-5低于撤机成功组(P<0.05);Pearson相关性分析显示外周血HCAR、DcR3与LUS、APACHEⅡ评分呈正相关,AQP-5与LUS、APACHEⅡ评分呈负相关(P<0.05);单因素、多因素分析均显示,外周血HCAR、DcR3、AQP-5影响撤机结局(P<0.05);外周血HCAR、DcR3、AQP-5预测撤机失败的截断值分别为4.10 mg/g、14.55μg/L、7.91μg/L,联合预测撤机失败的曲线下面积(AUC)为0.915(95%CI:0.850~0.958),大于各指标单独预测;以截断值为界分为低水平与高水平,外周血HCAR、DcR3高水平患者30 d生存率低于低水平患者,外周血AQP-5高水平患者30 d生存率高于低水平患者(P<0.05)。结论 ICU急性呼吸衰竭患者外周血HCAR、DcR3、AQP-5水平与撤机结局密切相关,联合检测可作为预测撤机失败的重要辅助手段,还能帮助临床判断死亡风险,为临床提供可靠的数据支持。 展开更多
关键词 重症监护室 急性呼吸衰竭 机械通气 超敏C反应蛋白与白蛋白比值 诱骗受体3 水通道蛋白-5 撤机结局
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加味清气化痰汤配合无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭临床研究 被引量:1
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作者 蔡惠芳 《新中医》 CAS 2024年第7期47-51,共5页
目的:观察对慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭患者以加味清气化痰汤配合无创正压通气治疗的临床效果。方法:将130例COPD急性加重期合并呼吸衰竭患者以随机简单化法分为治疗组与对照组,各65例。对照组以无创正压通气治疗,... 目的:观察对慢性阻塞性肺疾病(COPD)急性加重期合并呼吸衰竭患者以加味清气化痰汤配合无创正压通气治疗的临床效果。方法:将130例COPD急性加重期合并呼吸衰竭患者以随机简单化法分为治疗组与对照组,各65例。对照组以无创正压通气治疗,治疗组在对照组基础上联合加味清气化痰汤治疗。治疗14 d后评估2组临床疗效,并比较2组治疗前后肺功能、动脉血气指标、血清单核细胞趋化蛋白-1(MCP-1)、可溶性髓样细胞触发受体-1(sTREM-1)水平。结果:治疗后,治疗组总有效率96.92%,高于对照组87.69%(P<0.05)。治疗后,2组用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值的百分比(FEV_(1)%)均升高(P<0.05),且治疗组高于对照组(P<0.05)。治疗后,2组动脉血pH值、血氧分压(PaO_(2))均升高(P<0.05),二氧化碳分压(PaCO_(2))均降低(P<0.05),且治疗组PaO_(2)高于对照组(P<0.05),PaCO_(2)低于对照组(P<0.05)。治疗后,2组MCP-1、sTREM-1水平均降低(P<0.05),且治疗组低于对照组(P<0.05)。结论:针对COPD急性加重期合并呼吸衰竭患者采用加味清气化痰汤配合无创正压通气治疗效果显著,可改善患者肺功能、动脉血气指标,减轻炎性反应。 展开更多
关键词 慢性阻塞性肺疾病 急性加重期 清气化痰汤 无创正压通气 呼吸衰竭 肺功能 动脉血气指标
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乙酰半胱氨酸雾化吸入配合无创呼吸机NIPSV模式通过调节免疫炎症反应治疗AECOPD合并呼吸衰竭的机制
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作者 张维华 秦珊珊 +2 位作者 温思聪 吴平宇 宋昭光 《昆明医科大学学报》 CAS 2024年第7期113-118,共6页
目的探究乙酰半胱氨酸雾化吸入配合无创呼吸机压力支持通气(NIPSV)模式通过调节免疫炎症反应治疗慢性阻塞性肺疾病急性期(AECOPD)合并呼吸衰竭的机制。方法选取2020年2月至2022年12月于安徽省桐城市人民医院就诊的AECOPD合并呼吸衰竭患... 目的探究乙酰半胱氨酸雾化吸入配合无创呼吸机压力支持通气(NIPSV)模式通过调节免疫炎症反应治疗慢性阻塞性肺疾病急性期(AECOPD)合并呼吸衰竭的机制。方法选取2020年2月至2022年12月于安徽省桐城市人民医院就诊的AECOPD合并呼吸衰竭患者共计80例,依据治疗方案不同分为实验组(n=42)及对照组(n=38),实验组采用无创呼吸机NIPSV模式联合乙酰半胱氨酸雾化吸入,对照组采用无创呼吸机NIPSV模式,对比2组治疗前后肺功能:包括第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC;血气指标:动脉血氧分压(PaO_(2))、动脉血二氧化碳(PaCO_(2))、血氧饱和度(SaO_(2));血清指标:白介素-6(IL-6)、淀粉样蛋白A(SAA)、C反应蛋白(CRP)、T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+))水平,比较治疗期间不良反应发生率。结果治疗后实验组FEV1、FVC、FEV1/FVC水平均明显高于对照组及治疗前(P<0.05);治疗后实验组PaO_(2)、PaCO_(2)、SaO_(2)水平高于对照组及治疗前(P<0.05);治疗后实验组IL-6、SAA、CRP水平低于对照组及治疗前(P<0.05);治疗后2组CD3^(+)、CD4^(+)水平均升高,实验组高于对照组,CD8^(+)水平降低,实验组低于对照组(P<0.05);实验组不良反应发生率明显低于对照组(P<0.05)。结论AECOPD合并呼吸衰竭患者无创呼吸机NIPSV模式联合乙酰半胱氨酸吸入通过调节免疫炎症反应治疗后,能有效减轻炎性反应,提高肺功能及免疫功能的同时改善患者的血气指标。 展开更多
关键词 慢性阻塞性肺疾病急性期 呼吸衰竭 无创呼吸机压力支持通气 乙酰半胱氨酸
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急性呼吸衰竭患者血清超敏C反应蛋白/白蛋白比值、诱骗受体3与撤机结局的关系
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作者 任蔚 时月生 杨东明 《包头医学院学报》 CAS 2024年第2期58-61,86,共5页
目的:分析外周血超敏C反应蛋白/白蛋白比值(HCAR)、诱骗受体3(DcR3)与急性呼吸衰竭患者机械通气撤机结局的关系。方法:选取2020年11月至2021年11月接受机械通气治疗的102例急性呼吸衰竭患者为研究对象,根据撤机结局分为撤机失败组(n=21... 目的:分析外周血超敏C反应蛋白/白蛋白比值(HCAR)、诱骗受体3(DcR3)与急性呼吸衰竭患者机械通气撤机结局的关系。方法:选取2020年11月至2021年11月接受机械通气治疗的102例急性呼吸衰竭患者为研究对象,根据撤机结局分为撤机失败组(n=21)、撤机成功组(n=81)。比较两组自主呼吸测试(SBT)前、撤机后外周血HCAR、DcR3水平,分析HCAR、DcR3水平与急性呼吸衰竭患者撤机失败的关系,外周血HCAR、DcR3水平联合对急性呼吸衰竭患者撤机失败的预测价值,分析不同水平HCAR、DcR3发生撤机失败危险度。结果:撤机失败组SBT前、撤机后外周血HCAR、DcR3水平高于撤机成功组(P<0.05);Logistic分析发现,外周血HCAR、DcR3水平与急性呼吸衰竭患者撤机失败显著相关(P<0.05);SBT前、撤机后外周血HCAR、DcR3水平联合预测优于单独预测;SBT前、撤机后外周血HCAR、DcR3水平高水平发生撤机失败的危险度是低水平的1.125、1.633、1.893、2.236倍(P<0.05)。结论:急性呼吸衰竭患者外周血HCAR、DcR3水平增加,各指标联合可以为预测急性呼吸衰竭患者机械通气撤机结局提供参考。 展开更多
关键词 急性呼吸衰竭 HCAR DCR3 机械通气 撤机结局
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