Non-Invasive Positive Pressure Ventilation (NIPPV) in the Pregnant Patient: A Case Series

Rationale: Acute respiratory failure is an uncommon complication of pregnancy. However, it is the most frequent organ dysfunction associated with obstetric admissions to an intensive care unit. The obstetric population is a different group due to its physiology and the presence of the fetus that lacks evidence in the literature within the subject of ventilatory support. Noninvasive positive pressure ventilation (NIPPV) is often avoided due to the lack of knowledge on the safety and efficacy of this modality. Currently, there are no guidelines for the management of respiratory failure in pregnancy. Objectives: To provide evidence in support of the use of NIPPV as a safe and reasonable modality for pregnant patients with respiratory failure. Methods: We retrospectively reviewed medical records of 29 pregnant patients of the Obstetric Critical Care Unit of a tertiary hospital in Panamá City who received NIPPV from 2013 to 2015. Failure to response was defined as the lack of increase in the paO2/FiO2 ratio or clinical deterioration 6 hours after initiating NIPPV. Demographics, indication for NIPPV, duration of treatment, as well as maternal and fetal outcomes were collected. Measurements and Main Results: Mean age was 28.4 ± 6 years, mean body mass index 27.4 ± 3.3, and mean gestational age at admission was 305/7 ± 5 weeks. Twenty-four patients (82.8%) met the criteria for acute lung injury (ALI) and an additional two (6.9%) for acute respiratory distress syndrome (ARDS). The mean duration of ventilation was 50.6 ± 17.27 hours. Statistically significant differences were noted between the paO2/FiO2 ratios in failure and successful patients within 2 hours of NIPPV therapy (P = 0.007) and paO2/FiO2 ratio within 6 hours of NIPPV therapy (P = 0.03). Success was defined when the patient was administered NIPPV, resulting in an improvement (increase in pa/FiO2 ratio) of her ventilatory parameters. Three patients (10.3%) failed to respond to NIPPV and needed to be converted to invasive mechanical ventilation. Patients who required intubation had a longer duration of ICU stay (P = 0.006) and overall hospital stay (P = 0.03). None of patients presented aspiration during NIPPV therapy. Conclusion: The current series is the largest report of pregnant patients requiring ventilatory support who received NIPPV as first line of therapy. This report shows the usefulness of this ventilation modality, avoiding intubation with its risks, of a significant number of patients, especially ventilator-associated pneumonia.

The Value of Positive Pressure Ventilations for Clients in Acute Respiratory Distress as a Result of Cardiac and Pulmonary Issues

Objective: Research was conducted to examine benefits to using non-invasive ventilation (NIV) or continuous positive airway pressure (CPAP) early in the treatment of respiratory distress caused by pulmonary edema, chronic obstructive pulmonary disease (COPD) and asthma. Limitations to successful NIV and CPAP therapy were evaluated to determine how prolonged initiation of treatment may lead to hypoxemia (decreased oxygen in the blood) and hypercapnia (increased carbon dioxide in the blood) resulting in poor outcomes. Method: Reviews of literature from nursing and allied health data bases (CINAHL and ProQuest) with terms pulmonary edema, positive pressure device and non-invasive ventilation from 2010 to 2014 were used. Studies were conducted in the hospital and prehospital settings. Results: The literature search located 7 articles from CINAHL and 25 articles from ProQuest. A total of 6 of these articles were analyzed. Additional sources of data were obtained from Ignatavicius and Workman (2013) Medical-Surgical Nursing Patient-Centered Collaborative Care 7th edition and American Journal of Nursing (02/2013) Volume 113: 2. Conclusion: All of the articles concluded that early initiation of continuous positive airway pressure ventilations in the short-term was beneficial;however, late initiation of therapy required additional interventions. The studies indicated that early use of positive airway pressure in acute respiratory distress improved breath rate, heart rate and blood pressure. The use of positive airway pressure for respiratory distress may decrease the need for endotracheal intubation.

Effect of noninvasive positive pressure ventilation on weaning success in patients receiving invasive mechanical ventilation： a meta-analysis

Background Noninvasive positive pressure ventilation （NIPPV） has been proposed to shorten the duration of mechanical ventilation in intubated patients, especially those who fail initial weaning from invasive mechanical ventilation （IMV）. However, there are also some discrepancies in terms of weaning success or failure, incidence of re-intubation, complications observed during study and patient outcomes. The primary objective of this update was to specifically investigate the role of NIPPV on facilitating weaning and avoiding re-intubation in patients intubated for different etiologies of acute respiratory failure, by comparing with conventional invasive weaning approach. Methods We searched randomized controlled trials （RCTs） comparing noninvasive weaning of early extubation and immediate application of NIPPV with invasive weaning in intubated patients from PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Knowledge and Springerlink databases. Records from conference proceedings and reference lists of relevant studies were also identified. Results A total of 11 RCTs with 623 patients were available for the present analysis. Compared with IMV, NIPPV significantly increased weaning success rates （odds ratio （OR）： 2.50, 95% confidence interval （C/）： 1.46-4.30, P=0.0009）, decreased mortality （OR： 0.39, 95% CI： 0.20-0.75, P=0.005）, and reduced the incidence of ventilator associated pneumonia （VAP） （OR： 0.17, 95% CI： 0.08-0.37, P 〈0.00001） and complications （OR： 0.22, 95% CI： 0.07-0.72, P=0.01）. However, effect of NIPPV on re-intubation did not reach statistical difference （OR： 0.61, 95% CI： 0.33-1.11, P=0.11）. Conclusions Early extubation and immediate application of NIPPV is superior to conventional invasive weaning approach in increasing weaning success rates, decreasing the risk of mortality and reducing the incidence of VAP and complications, in patients who need weaning from IMV. However, it should be applied with caution, as there is insufficient beneficial evidence to definitely recommend it in terms of avoidinQ re-intubation.

Long-term non-invasive positive pressure ventilation in severe stable chronic obstructive pulmonary disease： a meta-analysis

Background The evidence for non-invasive positive pressure ventilation （NIPPV） used in patients with severe stable chronic obstructive pulmonary disease （COPD） is insufficient. The aim of the meta-analysis was to assess the treatment effects of long-term NIPPV on gas change, lung function, health-related quality of life （HRQL）, survival and mortality in severe stable COPD patients. Methods Randomized controlled trials （RCTs） and crossover studies comparing the treatment effects of NIPPV with conventional therapy were identified from electronic databases and reference lists from January 1995 to August 2010. Two reviewers independently assessed study quality. Data were combined using Review Manager 5.0. Both pooled effects and 95% confidence intervals were calculated. Results Five RCTs and one randomized crossover study with a total of 383 severe stable COPD patients were included NIPPV improved gas change significantly when using a higher inspiratory positive airway pressures. The weighted mean difference （WMD） for the partial pressure of carbon dioxide in artery （PaCO2） was -3.52 （-5.26, -1.77） mmHg and for the partial pressure of oxygen in artery （PaO2） 2.84 （0.23, 5.44） mmHg. There were significant improvements in dyspnea and sleep quality, but gained no benefits on lung function. The standardized mean difference （SMD） for the forced expiratory volume in 1 second （FEV1） was 0.00 （0.29, 0.29）. And the benefits for exercise tolerance, mood, survival and mortality remained unclear. Conclusions Patients with severe stable COPD can gain some substantial treatment benefits when using NIPPV, especially improvements in gas change, dyspnea and sleep quality. Studies of high methodological quality with large population, especially those based on a higher inspiratory positive airway pressures are required to provide more evidences.

GSH-Px、TLR4与NPPV治疗AECOPD效果的关系

目的探讨血清谷胱甘肽过氧化物酶(GSH-Px)及Toll样受体-4(TLR4)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者效果的关系。方法NPPV治疗的162例AECOPD患者,根据治疗第7天时的疗效分为预后良好组(100例)和预后不良组(62例);比较2组患者治疗第1、第3及第7天时的血清GSH-Px、TLR4水平,分析预后不良患者治疗第7天时血清GSH-Px及TLR4水平与血气指标、急性生理与慢性健康(APACHEⅡ)评分的相关性,采用logistic回归模型分析NPPV治疗AECOPD预后不良的影响因素。结果在治疗第1、第3及第7天时,预后良好组患者的GSH-Px水平逐渐升高,预后不良组的GSH-Px水平逐渐降低,差异具有统计学意义(P<0.05);在治疗第3和第7天时,预后良好组患者的TLR4水平逐渐降低,预后不良组的TLR4水平逐渐升高,差异具有统计学意义(P<0.05);预后不良组患者的血清GSH-Px水平与APACHEⅡ评分呈显著负相关关系(P<0.05),血清GSH-Px水平与PaO_(2)、pH、SaO_(2)呈显著正相关关系(P<0.05);预后不良组患者的TLR4水平与PaO2、pH呈显著负相关关系(P<0.05);年龄增大、APACHEⅡ评分及TLR4升高和合并冠心病是AECOPD患者NPPV治疗失败的独立危险因素(P<0.05);PaO_(2)、pH值(7.20~7.45)、SaO_(2)、ALB及GSH-Px升高是AECOPD患者NPPV治疗有效的保护性因素(P<0.05)。结论GSH-Px、TLR4与NPPV治疗AECOPD患者的疗效预后有关,与NPPV治疗失败患者的血气水平、APACHEⅡ评分有关。

HI-NPPV治疗AECOPD合并严重Ⅱ型呼吸衰竭的临床疗效

目的:慢性阻塞性肺疾病急性加重(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并严重Ⅱ型呼吸衰竭患者使用常规无创正压通气(non-invasive positive pressure ventilation,NPPV)通气失败的概率较高。本研究旨在探讨高压力NPPV(high intensity NPPV,HI-NPPV)治疗AECOPD合并严重Ⅱ型呼吸衰竭的临床疗效。方法:收集2013年7月至2023年7月因AECOPD伴严重Ⅱ型呼吸衰竭(血气分析pH值≤7.25)在重庆医科大学附属第二医院进行NPPV治疗的患者资料,进行回顾性病例对照研究。根据NPPV治疗过程中采用的吸气相气道正压(inspired positive airway pressure,IPAP)将患者分为2组:NPPV组(IPAP<20 cmH2O,1 cmH2O=0.098 kPa)和HI-NPPV组(20 cmH2O≤IPAP<30 cmH2O)。NPPV组和HI-NPPV组分别纳入99和95例患者。通过倾向性得分匹配法(propensity score matching,PSM)进行数据配比,共匹配得到86对数据。比较2组的主要结局指标(病死率、气管插管率)及次要结局指标[血气分析的pH值、动脉血氧分压(arterial partial pressure of oxygen,PaO_(2))和动脉血二氧化碳分压(arterial partial pressure of carbon dioxide,PaCO_(2)),不良反应率,住院时长]。结果:NPPV组和HI-NPPV组的气管插管率分别为6.98%和1.16%,2组之间差异有统计学意义(χ^(2)=4.32,P<0.05);NPPV组和HI-NPPV组的病死率分别为23.26%和9.30%,2组之间差异有统计学意义(χ^(2)=11.64,P<0.01)。HI-NPPV组治疗后24、48 h的PaO_(2)均高于NPPV组,PaCO_(2)均低于NPPV组,差异均有统计学意义(均P<0.05);治疗后24、48 h,2组之间p H值的差异无统计学意义(均P>0.05)。2组在不良反应率、住院时长方面的差异均无统计学意义(均P>0.05)。结论:HI-NPPV可通过迅速改善AECOPD合并严重Ⅱ型呼吸衰竭患者的通气状态,从而降低病死率及插管率,本研究为AECOPD合并严重Ⅱ型呼吸衰竭患者的治疗提供了新的思路。

Clinical Study of P_(ET)CO_2 in One-lung Ventilation

Fourty-eight patients (ASA physical status Ⅰ - Ⅱ) undergoing selected thoracotomy and pulmonectomy were studied. They were divided into two groups according to different respiratory modes, two-lung ventilation (TLV) and onelung ventilation (OLV) or TLV and OLV with a Bain cyclic system for CPAP on the side of operated lung. PETCO2 and PaCO2 were measured after 30 min TLV,30 min and 60 min OLV, and repeated TLV (R-TLV) 30 min after pulmonectomy, to evaluate the difference between PETCO2 and PaCO2 in OLV and to observethe effect of abating hypoxemia and discharge of CO2 in OLV with Bain system.Our results showed that the PaCO2 and PETCO2 in different test groups were normal though the measured values in OLV were slightly higher than that in TLV (P<0. 05) , and then they were recovered after R-TLV (P>0. 05). There was nosignificant difference between group 1. and 2. in OLV (P>0. 05). There was aclose correlation between PETCO2 and PaCO2 (P<0. 05). The differences of the calculated P(a-ET)CO2 and radio of PETCO2/PaCO2 in different ventilation modes were not significant. Hypoxemia in OLV was corrected by Bain system, but the discharge of CO2 was not affected. The results showed that measurement of PET CO2 as a non-invasive procedure can be commonly used to monitor OLV.

慢性阻塞性肺疾病患者有创通气拔管后经鼻高流量氧疗-无创正压通气序贯治疗的临床疗效观察

目的研究经鼻高流量氧疗(HFNC)-无创正压通气(NIPPV)序贯疗法在慢性阻塞性肺疾病(COPD)患者有创通气拔管后治疗中的效果。方法以回顾性分析为法,观察对象为2020年1月至2022年1月入院的130例有创通气拔管后的COPD患者,按照治疗方式不同分为研究组(65例)与对照组(65例),研究组行HFNC-NIPPV序贯治疗,对照组行NIPPV治疗。比较两组患者治疗前后舒适度评分、痰液黏稠度、动脉血气指标[动脉血氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))]水平与治疗后再插管率、重症监护室(ICU)停留时间、不良反应(腹胀、口咽部干燥、面部损伤)发生率。结果治疗前,两组患者的舒适度评分、痰液黏稠度、动脉血气指标水平差异均无统计学意义(P>0.05);治疗后,两组患者的舒适度评分与PaO_(2)均较治疗前明显升高,痰液黏稠度与PaCO_(2)均较治疗前明显下降,差异均有统计学意义(P<0.05);研究组治疗后舒适度评分与PaO_(2)均明显高于对照组,痰液黏稠度、PaCO_(2)、再插管率、不良反应发生率明显低于对照组,ICU停留时间明显短于对照组,差异均有统计学意义(P<0.05)。结论COPD患者有创通气拔管后HFNC-NIPPV序贯治疗效果显著,可有效提升患者舒适度,降低痰液黏稠度、再插管率及不良反应发生率,还可改善其动脉血气指标水平,促使其快速康复。

NICU早产儿无创正压通气护理质量评价指标的构建

目的:构建新生儿重症监护室(NICU)早产儿无创正压通气护理质量评价指标,为临床评价NICU早产儿无创正压通气护理质量提供依据。方法:以“结构-过程-结果”三维质量评价模型为基础,于2023年1月—4月采用德尔菲法对25名专家进行问卷函询,并通过层次分析法确立NICU早产儿无创正压通气护理质量评价指标内容及各指标权重。结果:共开展2轮函询,问卷有效回收率分别为92.0%、100.0%,专家权威系数为0.922,0.928,肯德尔和谐系数为0.156,0.180。最终构建了3级结构模式评价指标,设有一级指标3项、二级指标14项、三级指标78项。结论:构建的无创正压通气护理质量评价指标内容科学、合理,具有较强的专科特色,可为早产儿无创正压通气护理质量评价提供参考依据。

微创表面活性物质注射技术联合无创通气在早产儿轻中度新生儿呼吸窘迫综合征中的应用

目的探讨微创表面活性物质注射(LISA)技术联合无创通气(NIPPV)在早产儿轻中度新生儿呼吸窘迫综合征(NRDS)中的应用效果。方法选取2022年3月至2023年3月江西省妇幼保健院收治的80例NRDS患儿为研究对象,采用随机数字表法分为常规组与研究组,每组各40例。其中常规组传统技术联合NIPPV进行治疗,研究组使用LISA技术联合NIPPV进行治疗,比较两组患儿疗效、血气指标[pH值、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))及氧合指数(OI)]、临床指标[再次肺表面活性物质(PS)治疗例数、72 h内机械通气例数、机械通气时间、住院时间]及并发症发生情况。结果研究组总有效率(97.50%)高于常规组(80.00%),差异有统计学意义(P<0.05);治疗后,研究组pH、PaO_(2)及OI值均高于常规组,PaCO_(2)低于常规组,差异有统计学意义(P<0.05)。两组患儿再次PS发生率比较,差异无统计学意义(P>0.05)。研究组72 h内机械通气发生率低于常规组,机械通气时间及住院时间短于常规组,差异有统计学意义(P<0.05)。研究组并发症总发生率(5.00%)低于常规组(22.50%),差异有统计学意义(P<0.05)。结论在治疗早产儿轻中度NRDS患儿方面,LISA技术疗效确切,相较于传统技术其改善患儿血气指标的效果更加明显,同时可显著减少患儿机械通气次数及时间,缩短住院时间,并显著减少并发症的发生。

综合护理干预对阻塞性睡眠呼吸暂停低通气综合征患者生命质量的作用

目的:探讨综合护理干预对青海地区阻塞性睡眠呼吸暂停低通气综合征(OSAHS)患者生命质量的改善效果。方法:选取2019年1月至2021年12月在青海红十字医院睡眠医学科行多导睡眠监测(PSG)和无创呼吸机治疗的中重度OSAHS住院患者392例作为研究对象,根据收治的时间登记表单双号顺序将患者分为对照组(单号)和观察组(双号),每组196例。对照组给予普通护理,观察组给予综合护理。比较2组干预前后Epworth嗜睡量表(ESS)、焦虑自评量表(SAS)、睡眠呼吸暂停生命质量指数(SAQLl)评分及干预后持续气道正压通气(CPAP)治疗依从性。结果:干预后,2组患者ESS、SAS评分均低于本组干预前(均P<0.05),且观察组干预后ESS、SAS评分均低于对照组(均P<0.05)。干预后,2组患者SAQLI日常活动、社会影响、情感活动、症状评分均高于本组干预前(均P<0.05),且观察组干预后SAQLI日常活动、社会影响、情感活动、症状评分均高于对照组(均P<0.05)。观察组干预后完成CPAP治疗患者例数明显多于对照组(P<0.05)。结论:综合护理干预后可显著提高患者CPAP治疗的依从性,提高疗效,提高患者的生命质量。

呼吸科护士无创正压通气护理知信行现状调查及分析

目的:调查呼吸科护士无创正压通气(NIPPV)护理的知信行现状并分析呼吸科护士NIPPV护理行为的影响因素,为临床开展无创通气护理培训及管理提供依据。方法:采用自行设计的NIPPV护理知信行问卷对华南地区22所医院呼吸科的护士进行问卷调查,并分析NIPPV护理行为的影响因素。结果:共回收有效问卷215份,呼吸科护士NIPPV护理知信行总量表、知识维度、态度维度、行为维度得分分别为(98.29±12.51)分、(18.94±4.35)分、(28.44±4.75)分和(50.90±8.73)分。多元线性回归分析结果显示,NIPPV护理行为的主要影响因素为工作年限、是否接受过NIPPV护理知识或技能培训、所在科室是否有NIPPV护理流程规范、知识得分、态度得分。结论:呼吸科护士对无创通气护理的态度较为积极,无创通气护理的行为总体较好,但无创通气护理知识掌握程度有待提高。无创通气护理行为的主要影响因素为知识和态度、工作年限、是否接受过NIPPV护理知识或技能培训、所在科室是否有NIPPV护理流程规范。护理管理者应加强呼吸科护士的NIPPV护理知识和技能的培训,医疗机构应制订NIPPV护理操作流程规范,以规范护士的临床工作,提高NIPPV病人的护理质量。

专职护理小组结合精细化护理在BiPAP呼吸机治疗慢阻肺急性加重期合并呼吸衰竭患者中的应用

目的:分析专职护理小组结合精细化护理在无创正压通气(non-invasive positive pressure ventilation,NPPV)呼吸机治疗慢性阻塞性肺疾病急性加重期(acute exacerbation of chronic obstructive pulmonary disease,AECOPD)合并呼吸衰竭患者中的应用价值。方法:选取江苏省东台市人民医院2021年4月至2022年4月BiPAP(bilevel positive airway pressure,BiPAP)呼吸机治疗的AECOPD合并呼吸衰竭患者82例,随机分为对照组(n=41)、观察组(n=41),对照组为常规护理,观察组为专职护理小组结合精细化护理,比较两组患者肺功能、血气指标及并发症发生率。结果:护理前,两组患者肺功能比较差异无统计学意义(P>0.05),护理后观察组更优(P<0.05);护理前,两组患者血气指标比较差异无统计学意义(P>0.05),护理后观察组较对照组更优(P<0.05),且观察组患者并发症发生率较对照组更低(P<0.05)。结论:对AECOPD合并呼吸衰竭患者,采用专职护理小组结合精细化护理可改善肺功能、血气指标,降低并发症发生率。

经鼻高流量湿化治疗仪治疗慢阻肺急性加重期伴呼吸性酸中毒患者的效果

目的:分析经鼻高流量湿化治疗仪应用于慢阻肺急性加重期伴呼吸性酸中毒的治疗效果,探讨其对患者血气指标及肺功能的影响。方法:回顾性分析2022年1月—2023年10月在北京市昌平区医院呼吸与危重症学科治疗的100例慢阻肺急性加重伴呼吸性酸中毒患者的临床资料。根据治疗方式的不同分为两组,各50例。观察组接受经鼻高流量湿化氧疗,对照组接受无创正压通气治疗。比较两组的血气指标、肺功能指标、治疗效果及不良反应发生情况。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P<0.05)。治疗前,两组血气指标、肺功能指标比较,差异无统计学意义(P>0.05);治疗后,两组pH值、氧分压(PaO_(2))、氧合指数(OI)均高于治疗前,二氧化碳分压(PaCO_(2))低于治疗前,且观察组pH值、PaO_(2)、OI高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗后,两组第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、呼气峰流速值(PEF)、第1秒用力呼气容积/用力肺活量(FEV_(1)/FVC%)均高于治疗前,且观察组高于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论:经鼻高流量湿化氧疗、无创正压通气治疗都是慢阻肺急性加重期伴呼吸性酸中毒辅助通气的有效方法,而经鼻高流量湿化氧疗可有效提高治疗效果,改善患者血气指标及肺功能,不良反应少,安全性更高。

BAL与NPPV治疗COPD伴肺不张患者的效果

目的:探讨纤支镜肺泡灌洗(BAL)与无创正压通气(NPPV)治疗慢性阻塞性肺疾病(COPD)伴肺不张患者的效果。方法:选取2020年2月—2023年2月浠水县中医院呼吸科收治的84例COPD伴肺不张患者。根据随机数表法将其分为治疗组和对照组,各42例。两组均给予常规药物治疗,治疗组采用BAL治疗,对照组采用NPPV治疗。比较两组治疗前后呼吸困难、肺功能指标、动脉血气指标、相关指标。结果:治疗后,两组改良的医学研究委员会呼吸困难量表(mMRC)评分降低,治疗组mMRC评分低于对照组,差异有统计学意义(P<0.05)。治疗后,两组用力肺活量(FVC)、第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值的百分比(FEV_(1)%pred)均升高,治疗组FVC、FEV_(1)、FEV_(1)%pred均高于对照组,差异有统计学意义(P<0.05)。治疗后,两组动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))均显著升高,动脉血二氧化碳分压(PaCO_(2))降低,治疗组SaO_(2)、PaO_(2)均高于对照组,PaCO_(2)低于对照组,差异有统计学意义(P<0.05)。治疗后,两组可溶性触发受体表达的基因1(sTREM-1)和高迁移率族蛋白B1(HMGB1)水平均显著降低,治疗组sTREM-1、HMGB1水平均低于对照组,差异有统计学意义(P<0.05)。结论:BAL与NPPV治疗均能有效改善COPD伴肺不张患者的症状和肺功能,且BAL治疗的效果优于NPPV治疗。两种治疗方式均能降低COPD伴肺不张患者的sTREM-1、HMGB1水平,提示两种治疗方式均能减轻炎症反应,且BAL治疗的抗炎作用优于NPPV治疗。

吴茱萸热罨包联合穴位贴敷治疗COPD无创通气患者腹胀的效果

目的观察吴茱萸热罨包联合穴位贴敷治疗慢性阻塞性肺疾病(COPD)无创通气患者并发腹胀的效果。方法选取南昌大学第二附属医院呼吸与危重症医学科收治的60例COPD无创通气腹胀患者作为研究对象,按照随机数字表法将其分为观察组和对照组,每组30例。对照组予常规治疗及护理,观察组在对照组基础上加用吴茱萸热罨包联合穴位贴敷,2组均连续治疗3 d。比较2组患者治疗前后的肠鸣音次数、腹围及临床疗效。结果治疗后观察组每分钟肠鸣音次数多于对照组(P<0.05),腹围小于对照组(P<0.05),治疗总有效率高于对照组(P<0.05)。结论吴茱萸热罨包联合穴位贴敷治疗COPD无创通气患者并发腹胀,可促进患者肠道蠕动,改善腹胀状况。

无创通气AVAPS模式对慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者的治疗价值

目的分析无创机械通气平均容积保证压力支持(AVAPS)模式对慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者的治疗价值。方法选取2021年1月~2022年12月在北京市房山区良乡医院呼吸科住院的82例慢性阻塞性肺疾病伴Ⅱ型呼吸衰竭患者,随机数表法分为对照组(n=42)和观察组(n=40)。对照组采用双水平正压通气(BiPAP)S T模式+内科治疗方案,观察组采用AVAPS模式(S T+VT目标)+内科治疗方案。观察两组患者血气指标变化、通气效果和呼吸机相关并发症发生率。结果对照组患者呼吸机不耐受给予内科治疗5例、治疗失败气管插管者8例;观察组40例,呼吸机不耐受2例、治疗失败气管插管者3例,并且插管后进呼吸重症监护室(RICU)治疗,无1人死亡,其余患者全都好转出院。机械通气治疗后,两组患者pH值均上升,二氧化碳分压(PaCO_(2))降低,与机械通气前比较,差异有统计学意义(P<0.05);观察组机械通气不同时刻pH值的上升与PaCO_(2)降低优于对照组,但差异无统计学意义(P>0.05)。观察组平均潮气量(VT)(520.00±50.00)ml、每分钟静息通气量(VE)(9.77±1.30)L min高于对照组,呼吸频率(RR)(16.00±1.00)次min、平均漏气量(Lleak)(18.00±6.00)L min明显低于对照组,人均呼吸机吸氧时间日(TA)(7.35±2.44)h和人均带机时间(TB)(52.89±9.85)h高于对照组,差异有统计学意义(t=9.979、6.999、11.366、9.347、7.944、11.672,P<0.05)。观察组患者机械通气治疗依从性90.0%高于对照组71.43%,差异有统计学意义(χ^(2)=4.499,P<0.05)。观察组气管插管率7.50%、面部压伤7.50%、胃肠胀气5.00%、吸入性肺炎2.50%和眼结膜炎2.50%均低于对照组,差异有统计学意义(P<0.05)。结论无创机械通气平均容积保证压力支持AVAPS模式减少呼吸肌做功,人机协调性好,较BiPAP显示出一定的优越性。

经鼻高流量湿化氧疗与无创正压通气治疗慢性阻塞性肺疾病急性加重期合并Ⅱ型呼吸衰竭患者的效果

目的 探讨经鼻高流量湿化氧疗(HFNC)与无创正压通气(NIPPV)治疗伴有Ⅱ型呼吸衰竭(Ⅱ-RF)慢性阻塞性肺疾病急性加重期(AECOPD)患者的效果。方法 选取2022年1—12月80例AECOPD合并Ⅱ-RF患者,依据通气方式分为HFNC组及NIPPV组,各40例,对比两组临床疗效、并发症发生率,比较两组治疗前后血氧饱和度、C反应蛋白(CRP)、白细胞计数(WBC)、白细胞介素-6(IL-6)、丙二醛(MDA)、髓过氧化物酶(MPO)、超氧化物歧化酶(SOD)水平。结果 HFNC组总有效率(92.50%)高于NIPPV组(75.00%)(P<0.05);治疗后,与NIPPV组及治疗前相比,HFNC组血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))更高,动脉血二氧化碳(PaCO_(2))更低(P<0.05);治疗后HFNC组CRP、IL-6、WBC水平低于NIPPV组及治疗前(P<0.05);治疗后HFNC组MDA、MPO低于NIPPV组及治疗前,SOD高于NIPPV组及治疗前(P<0.05);HFNC组并发症发生率低于NIPPV组(P<0.05)。结论 经HFNC治疗后可改善AECOPD合并Ⅱ-RF患者血气功能,减轻患者机体炎症状态,降低机体氧化应激,提高患者舒适度,降低并发症发生率,可促进患者病情较快恢复。

老年阻塞性睡眠呼吸暂停患者无创正压通气应用规范专家共识

由于老年人上气道神经肌肉功能减弱、呼吸调节功能不稳定等特点,导致阻塞性睡眠呼吸暂停(OSA)在老年人群中普遍存在。OSA是多种常见慢性疾病的危险因素,影响老年人的认知功能及多系统器官功能。因此,对老年人OSA进行有效的治疗干预是极为重要的。中国老年医学学会睡眠医学分会作为发起单位,组织国内相关领域的专家,参考国内外临床研究,就老年OSA患者无创正压通气(NPPV)治疗的操作流程、要求具体的方式和方法等内容进行反复探讨,最终制订本专家共识,旨在为规范国内老年OSA患者NPPV治疗提供参考。

降钙素原窗在AECOPD合并呼吸衰竭患者行有创-无创序贯通气中的应用

目的探讨"降钙素原窗(PCT窗)"在慢性阻塞性肺疾病急性加重(AECOPD)合并呼吸衰竭患者行有创-无创序贯通气切换点选取中的应用价值。方法选取AECOPD合并Ⅱ型呼吸衰竭需有创通气治疗的患者48例,随机分为实验组25例,对照组23例。2组患者均插管有创机械通气,给予抗感染、糖皮质激素等综合治疗。出现PCT窗后,实验组及时拔管转为经口/鼻面罩行无创正压机械通气(NIPPV)。对照组以同步间歇强制通气(SIMV)+压力支持通气(PSV)模式逐步过渡到PSV模式继续有创通气。结果 2组患者病死率,脱机24 h后心率(HR)、呼吸频率(RR)及p H、动脉氧分压[p(O2)]、二氧化碳分压[p(CO2)],总通气时间、再插管次数及重症监护病房(ICU)留住时间差异无统计学意义(P>0.05)。实验组有创通气时间及发生呼吸机相关性肺炎(VAP)例数显著少于对照组(P<0.05或P<0.01)。结论以PCT窗作为AECOPD有创-无创序贯通气转换指标,可缩短有创通气时间、降低VAP发生率。