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.

Cardiopulmonary Stability on a Patient with Hip Fracture and Severe Pulmonary Hypertension, Anesthetized with Lumbar-Sacral Plexus Block and Non-Invasive Ventilation: Case Report

Background: Pulmonary hypertension is defined as a mean arterial pressure in the pulmonary artery exceeding 20 mm Hg at rest, measured by means of right heart catheterization. Patients with pulmonary hypertension undergoing surgical procedures such as hemiarthroplasty present a high risk of fatal complications. Nonetheless, there are no widely accepted protocols explaining their perioperative care in great detail. Case presentation: We present a case with an 89-years-old patient, with comorbidities such as GOLD 4D chronic obstructive pulmonary disease (COPD) and, as a consequence of this, severe pulmonary hypertension with signs of right ventricular dysfunction, thus requiring of pulmonary vasodilator, that has suffered a subcapital hip fracture requiring urgent surgery. Surgery is carried out successfully, under regional lumbar-sacral plexus block and sedation assisted by non-invasive ventilation. Conclusion: Multidisciplinary specialized treatment, preoperative optimization, as well as the careful selection of both the surgical and anesthetic techniques to be used, are among the strategies that improve the perioperative outcome in patients with pulmonary hypertension with right ventricle systolic dysfunction. Regional lumbar-sacral plexus block plus sedation is a technique that maintains hemodynamic stability;however, these patients require advance measures and postoperative monitoring under intensive care.

Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery

Background: Cardiothoracic surgery is a common cause of acute respiratory failure and is associated with increased morbidity and mortality. We aimed to compare the outcomes of open heart surgery patients treated using oxygen delivery devices with patients who receive NIV as a first-line therapy for hypoxemic respiratory failure. Materials and Methods: 40 patients who developed acute hypoxemic respiratory failure after open heart surgery and admitted to cardiothoracic ICU 20 patients received NIV and 20 patient received oxygen by venture mask. For all patients the following measurements were performed before and after CPAP AND Venture use: CBC, blood urea, serum creatinine body temperature, chest X-ray, Arterial blood gases (arterial pH, sodium bicarbonate, pcO2, SpO2 and PaO2-to-FiO2 ratio). Results: Mean PO2 and SO2 have increased after using of both venture and Cpap, increase in both PCO2 and HCO3 levels after using Venturi mask, CPAP mask was superior to venturi mask in avoiding the need of intubation, decreasing The ICU stay median length and also median length of hospitalization, all were lower in CPAP group than venture group. Also the mortality rate was lower in CPAP group than the venturi group. Conclusion: Using CPAP mask in severe AHRF following open heart surgery can avoid intubation, decreases the levels of tachypnea and arterial hypoxemia, decreases ICU stay, the length of hospitalization and also decreases the mortality rate compared with patients receiving high-concentration oxygen therapy with venture mask.

有创-无创序贯机械通气用于重症呼吸衰竭中的效果研究

目的探究对重症呼吸衰竭患者实施有创-无创序贯机械通气的效果。方法86例重症呼吸衰竭患者作为研究对象,采用随机数表法分为对照组及观察组,每组43例。对照组实施传统有创机械通气治疗,观察组实施有创-无创序贯机械通气治疗。对比两组患者治疗前后的血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、动脉血氧饱和度(SaO_(2))]及肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、最大呼气峰流速(PEF)]水平,治疗时间(有创通气时间、总机械通气时间)和住院时间,治疗后的应激反应指标[去甲肾上腺素(NE)、肾上腺素(E)、血管紧张素Ⅱ(ATⅡ)]、生命体征(心率、呼吸频率),撤机成功率、再次插管率、呼吸机相关肺炎发生率。结果两组患者治疗后的PaO_(2)、SaO_(2)高于本组治疗前,PaCO_(2)低于本组治疗前,且观察组的PaO_(2)(73.03±5.35)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(92.46±4.60)%高于对照组的(66.24±4.97)mm Hg、(85.18±3.79)%,PaCO_(2)(41.09±0.54)mm Hg低于对照组的(44.98±0.63)mm Hg(P<0.05)。两组患者治疗后的FEV1、FVC、PEF高于本组治疗前,且观察组的FEV1(3.21±0.34)L、FVC(3.89±0.29)L、PEF(3.35±0.60)L/s高于对照组的(2.29±0.24)L、(2.74±0.21)L、(2.90±0.71)L/s(P<0.05)。观察组有创通气时间、总机械通气时间、住院时间分别为(6.07±1.21)、(8.70±1.53)、(12.33±1.82)d,比对照组的(11.46±1.77)、(11.46±1.77)、(18.64±2.35)d更短(P<0.05)。观察组治疗后应激反应指标NE、E、ATⅡ水平分别为(122.80±17.92)ng/ml、(94.52±8.52)ng/ml、(31.05±2.98)pg/ml,比对照组的(209.59±21.06)ng/ml、(164.45±11.67)ng/ml、(55.69±4.13)pg/ml更低(P<0.05)。观察组治疗后心率为(88.21±4.87)次/min、呼吸频率为(15.98±0.81)次/min,低于对照组的(95.70±6.13)、(19.59±1.25)次/min(P<0.05)。观察组撤机成功率93.02%(40/43)高于对照组的72.09%(31/43),再次插管率2.33%(1/43)、呼吸机相关肺炎发生率4.65%(2/43)低于对照组的18.60%(8/43)、20.93%(9/43)(P<0.05)。结论在重症呼吸衰竭患者治疗中,行有创-无创序贯机械通气治疗疗效确切,有助于加快患者病情康复速度,促进患者血气分析指标、肺功能改善,减轻患者应激反应,提升撤机成功率,降低呼吸机相关肺炎发生风险,推广可行性较高。

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。

基于时机理论的有创-无创序贯性机械通气疗法联合高流量氧疗在轻中度ARDS中的治疗效果

目的探讨基于时机理论的有创-无创序贯性机械通气疗法联合高流量氧疗在轻中度急性呼吸窘迫综合征(ARDS)中的治疗效果。方法选择2022年10月至2024年1月我院收治的80例轻中度ARDS患者作为研究对象,按随机数字表法分为对照组和观察组,每组40例。对照组实施常规机械通气联合高流量氧疗法,观察组予以基于时机理论的有创-无创序贯性机械通气联合高流量氧疗法。观察两组患者治疗24、48 h后的血气分析指标、循环指标、治疗相关指标和呼吸机相关性肺炎的发生情况。结果治疗24、48 h后,两组患者的呼吸频率(RR)、二氧化碳分压(PaCO_(2))、氧合指数(PaO_(2)/FiO_(2))、心率(HR)、平均动脉压(MAP)等循环指标比较,差异均无统计学意义(均P>0.05)。两组患者的有创机械通气时间、总机械通气时间、住ICU时间比较,观察组均明显短于对照组,差异均有统计学意义(P<0.05)。观察组的呼吸机相关性肺炎发生率低于对照组,差异有统计学意义(P<0.05)。结论基于时机理论的有创-无创序贯性机械通气疗法联合高流量氧疗应用于轻中度的ARDS患者的效果与常规治疗方法相当,但在机械通气持续时间、呼吸机相关性肺炎的发生方面具有明显优势,值得临床应用。

无创呼吸机对急性心力衰竭合并呼吸衰竭患者心肺功能及肌酸激酶同工酶(CK-MB)的影响分析

目的评估无创呼吸机应用在急性心力衰竭(AHF)合并呼吸衰竭(RF)患者治疗中的效果及对心肺功能、肌酸激酶同工酶(CK-MB)的影响。方法研究时间段2021年1月至2022年8月,研究对象80例AHF合并RF患者,分组方法:随机数字表法[对照组(40例,行常规药物治疗)、观察组(40例,加用无创呼吸机治疗)],评价组间治疗有效性、血气结果、心肺功能、血清学指标。结果(1)较之对照组(75.00%),观察组治疗有效率(95.00%)更高,P<0.05;(2)治疗前,组间血气结果[酸碱度(pH)、动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))]、心肺功能[心率(HR)、心脏指数(CI)、左室射血分数(LVEF)、用力肺活量(FVC)、最大呼气容量(PEF)、1(LVEF)、用力肺活量(FVC)]、血清学指标[CK-MB、氨基末端B型钠尿肽原(NT-pro BNP)、心肌肌钙蛋白I(cTnI)]无差异,P>0.05;治疗后,观察组血气结果(pH、SaO_(2)、PaO_(2))、心肺功能(HR、CI、LVEF、FVC、PEF、FEV1)、血清学指标(CK-MB、NT-pro BNP、cTnI)更佳,P<0.05。结论对AHF合并RF患者行无创呼吸机治疗,能够改善心肺功能、血气分析结果,降低CK-MB、NT-pro BNP、cTnI水平,提高治疗有效性,值得推广。

无创呼吸机与高流量氧疗对AECOPD合并呼吸衰竭患者呼吸功能及血清IL-6、IL-8、TNF-α水平的影响比较

目的分析比较无创呼吸机与高流量氧疗对慢性阻塞性肺疾病急性加重期(AECOPD)合并呼吸衰竭患者呼吸功能及血清白细胞介素-6(IL-6)、白细胞介素-8(IL-8)、肿瘤坏死因子-α(TNF-α)水平的影响。方法选择60例AECOPD合并呼吸衰竭患者,以随机数表方式分为对照组与研究组,各30例。两组均给予对症支持性治疗,对照组患者予以无创呼吸机治疗,研究组患者则给予高流量氧疗治疗。比较两组患者治疗效果、并发症发生情况及治疗前后的肺功能[用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、第1秒用力呼气容积与用力肺活量的比值(FEV1/FVC)]、血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))与血氧饱和度(SpO_(2))]、血清炎性因子(IL-6、IL-8、TNF-α)水平。结果与对照组(76.67%)相比,研究组治疗总有效率(96.67%)更高(P<0.05)。治疗后,两组FVC、FEV1、FEV1/FVC水平均高于治疗前,且研究组FVC(2.92±0.46)L、FEV1(2.79±0.43)L、FEV1/FVC(81.48±7.67)%分别高于对照组的(2.15±0.35)L、(2.04±0.34)L、(74.72±6.59)%(P<0.05)。治疗后,两组PaO_(2)、PaCO_(2)、SpO_(2)水平较治疗前改善,且研究组PaO_(2)(75.89±7.73)mm Hg(1 mm Hg=0.133 kPa)、SpO_(2)(92.94±5.79)%均较对照组的(68.37±6.69)mm Hg、(87.78±6.53)%高,PaCO_(2)(43.48±4.28)mm Hg较对照组的(49.73±4.84)mm Hg低(P<0.05)。治疗后,两组IL-6、IL-8、TNF-α水平均低于治疗前,且研究组血清IL-6、IL-8、TNF-α水平分别为(12.27±1.17)、(27.27±2.58)、(17.08±1.66)pg/ml,均低于对照组的(17.83±1.68)、(34.72±3.39)、(23.17±2.28)pg/ml(P<0.05)。在并发症发生率上,研究组、对照组分别为6.67%、30.00%,研究组更低(P<0.05)。结论对AECOPD合并呼吸衰竭患者采用高流量氧疗进行治疗的效果确切,能改善患者呼吸功能,并降低血清炎性因子水平,同时患者的并发症发生率更低,值得推广。

特布他林雾化吸入联合无创-有创序贯通气治疗慢性阻塞性肺疾病急性加重期患者的效果及对肺功能和相关因子水平的影响

目的探讨特布他林雾化吸入联合无创-有创序贯通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)患者的效果及对肺功能和血清白细胞介素8(IL-8)、髓过氧化物酶(MPO)、嗜酸性粒细胞阳离子蛋白(ECP)水平的影响。方法选取2020年8月至2022年8月诊治的104例AECOPD患者作为研究对象,按照随机数字表法分为对照组(予以特布他林雾化吸入联合常规有创通气治疗)与观察组(予以特布他林雾化吸入联合无创-有创序贯通气治疗),各52例,2组均持续治疗7 d。比较2组患者临床总有效率、肺功能[第1秒用力呼气容积(FEV_(1))、FEV_(1)占预计值百分比(FEV_(1)%)、FEV_(1)/用力肺活量(FVC)比值]、血气分析指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、呼出气一氧化氮(FeNO)、IL-8、MPO、ECP及撤机失败、二次插管、呼吸机相关性肺炎(VAP)发生率。结果观察组总有效率高于对照组[96.2%(50/52)比82.7%(43/52)](P<0.05)。治疗后,观察组FEV_(1)、FEV_(1)%、FEV_(1)/FVC比值、PaO_(2)均高于对照组,而PaCO_(2)、FeNO、IL-8、MPO、ECP均低于对照组(均P<0.05)。观察组撤机失败率、二次插管率、VAP发生率均低于对照组[0比7.7%(4/52)、0比7.7%(4/52)、1.9%(1/52)比13.5%(7/52)],差异均有统计学意义(均P<0.05)。结论特布他林雾化吸入联合无创-有创序贯通气治疗AECOPD具有较为理想效果,不仅能改善患者肺功能,并且能降低IL-8、MPO、ECP水平。

Effect of metronome rates on the quality of bag-mask ventilation during metronome-guided 30:2 cardiopulmonary resuscitation:A randomized simulation study

BACKGROUND: Metronome guidance is a feasible and effective feedback technique to improve the quality of cardiopulmonary resuscitation(CPR). The rate of the metronome should be set between 100 to 120 ticks/minute and the speed of ventilation may have crucial effect on the quality of ventilation. We compared three different metronome rates(100, 110, 120 ticks/minute) to investigate its effect on the quality of ventilation during metronome-guided 30:2 CPR.METHODS: This is a prospective, randomized, crossover observational study using a Respi Trainer r. To simulate 30 chest compressions, one investigator counted from 1 to 30 in cadence with the metronome rate(1 count for every 1 tick), and the participant performed 2 consecutive ventilations immediately following the counting of 30. Thirty physicians performed 5 sets of 2 consecutive(total 10) bag-mask ventilations for each metronome rate. Participants were instructed to squeeze the bag over 2 ticks(1.0 to 1.2 seconds depending on the rate of metronome) and defl ate the bag over 2 ticks. The sequence of three different metronome rates was randomized.RESULTS: Mean tidal volume significantly decreased as the metronome rate was increased from 110 ticks/minute to 120 ticks/minute(343±84 m L vs. 294±90 m L, P=0.004). Peak airway pressure significantly increased as metronome rate increased from 100 ticks/minute to 110 ticks/minute(18.7 vs. 21.6 mm Hg, P=0.006).CONCLUSION: In metronome-guided 30:2 CPR, a higher metronome rate may adversely affect the quality of bag-mask ventilations. In cases of cardiac arrest where adequate ventilation support is necessary, 100 ticks/minute may be better than 110 or 120 ticks/minute to deliver adequate tidal volume during audio tone guided 30:2 CPR.

MiR-16-5p plays an inhibitory role in human non-small cell lung cancer through Fermitin family member 2

Increasing evidence indicates that aberrant expressions of some microRNAs are associated with cancer progression.However,the roles and biological mechanisms of miRNA-16-5p in human non-small cell lung cancer(NSCLC)are not to be well studied.Here,we validated that the expression of miR-16-5p was decreased significantly in NSCLC samples and cell lines.The correlation between the clinicopathological features of NSCLC and the miR-16-5p expression showed that the expression of miR-16-5p in non-small cell lung cancer was linked with the advanced TNM stage,positive lymph node metastasis,with short overall survival(OS).Also,a negative correlation between miR-16-5p and Fermitin family member 2(FERMT2)was observed,implying there may be a potential link about their regulation.The hypothesis was further confirmed by in-silico analysis and dual-luciferase reporter assay.Moreover,we demonstrated that the transfections of miR-16-5p mimics could alter some biological characteristics of NSCLC cells remarkably accomplished by the expression variance of FERMT2 in vitro and in vivo assays.Summarily,this study demonstrated that miR-16-5p,as a tumor suppression factor in NSCLC by targeting FERMT2,could serve as one promising biomarker in the prediction for NSCLC patients.

有创-无创序贯机械通气对重症肺炎合并呼吸衰竭患者的影响

目的:探讨有创-无创序贯机械通气在重症肺炎(SP)合并呼吸衰竭患者中的应用效果。方法:选取2020年6月—2022年6月泉州市第一医院收治的86例SP合并呼吸衰竭患者。根据随机数表法将其分为对照组和观察组,各43例。对照组给予有创机械通气治疗。观察组给予有创-无创序贯机械通气治疗。比较两组临床相关指标,治疗前及治疗7 d后血气指标、炎症因子、心肌损伤标志物,治疗前和治疗14 d后的肺功能指标及并发症。结果:观察组氧疗时间、有创通气时间及住院时间分别为(12.36±1.45)d、(5.25±1.06)d、(18.36±2.14)d,均短于对照组的(20.41±2.35)d、(13.52±1.72)d、(25.44±2.43)d,差异有统计学意义(P<0.05)。治疗7 d后,观察组血氧分压(PaO_(2))为(87.69±6.25)mmHg(1 mmHg=0.133 kPa),高于对照组的(80.54±6.19)mmHg,二氧化碳分压(PaCO_(2))为(42.69±4.24)mmHg,低于对照组的(46.07±4.32)mmHg,差异有统计学意义(P<0.05)。治疗14 d后,观察组第1秒用力呼气容积(FEV_(1))、用力肺活量(FVC)、FEV_(1)/FVC%分别为(2.21±0.42)L、(3.26±0.55)L、(67.79±6.15)%,高于对照组的(1.78±0.37)L、(2.87±0.49)L、(62.02±5.89)%,差异有统计学意义(P<0.05)。治疗7 d后,观察组白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、白细胞计数(WBC)水平分别为(63.58±6.44)pg/mL、(1.58±0.23)μg/mL、(6.75±1.12)×10^(9)/L,均低于对照组的(71.42±7.27)pg/mL、(2.43±0.35)μg/mL、(9.48±1.37)×10^(9)/L,差异有统计学意义(P<0.05)。治疗7 d后,观察组心肌肌钙蛋白I(cTnI)、N末端脑钠肽前体(NT-proBNP)、心钠肽水平(ANP)分别为(0.35±0.06)ng/mL、(70.63±6.25)pg/mL、(142.32±8.51)pg/mL,均低于对照组的(0.46±0.11)ng/mL、(78.59±6.34)pg/mL、(155.76±10.12)pg/mL,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论:有创-无创序贯机械通气可加快SP合并呼吸衰竭患者血气复常,减轻肺部炎症反应,降低心肌损伤标志物水平,缩短有创通气时间,促进肺功能恢复,且并发症少。

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.

鼻腔喷雾对ICU重症肺炎有创-无创序贯机械通气患者的护理效果评价

目的探讨鼻腔喷雾护理对ICU重症肺炎有创-无创序贯机械通气患者下呼吸道菌群等的影响。方法选取2021年6月—2022年6月重症监护病房(ICU)收治的重症肺炎有创-无创序贯机械通气患者88例为研究对象。按照组间基本特征具有可比性的原则将患者分为观察组和对照组,每组44例。对照组行有创-无创序贯机械通气常规护理,观察组在常规护理基础上行0.9%氯化钠溶液鼻腔喷雾护理,每次4喷,每天3次,比较两组干预前后鼻腔分泌物评分、鼻腔舒适性评分,并记录两组下呼吸道菌群、呼吸机相关肺炎(VAP)、鼻腔黏膜出血情况及患者满意率。结果观察组干预后鼻腔分泌物评分及鼻腔VAS评分低于对照组,差异具有统计学意义(P<0.05)。观察组C反应蛋白恢复正常时间、有创-无创序贯机械通气时间、入住ICU时间、总住院时间短于对照组,差异具有统计学意义(P<0.05)。观察组下呼吸道菌群阳性检出率、VAP发生率及鼻腔黏膜出血发生率低于对照组,差异具有统计学意义(P<0.05)。观察组护理满意率高于对照组,差异具有统计学意义(P<0.05)。结论鼻腔喷雾护理可有效减少重症肺炎有创-无创序贯机械通气患者鼻腔分泌物,提高患者通气舒适性,可有效预防下呼吸道菌群定值,降低VAP及鼻腔黏膜出血发生率,改善预后,提高治疗满意率。

布地奈德雾化吸入配合无创机械通气治疗老年慢性阻塞性肺疾病并发呼吸衰竭的疗效研究

目的 探究布地奈德雾化吸入配合无创机械通气治疗慢性阻塞性肺疾病(COPD)并发呼吸衰竭的老年患者的临床效果。方法 选取2022年2月至2023年2月首都医科大学附属北京友谊医院收治的82例COPD并发呼吸衰竭的老年患者82例,采用随机数字表法分为对照组和观察组,每组41例。对照组接受无创机械通气治疗,观察组在对照组治疗的基础上给予布地奈德(2 mg/次,2次/d)雾化吸入治疗,两组患者均治疗1周。比较两组治疗前后的肺功能、血气指标、生命体征指标、临床症状评分及血清低氧诱导因子-1α、血清淀粉样蛋白A水平,并比较两组治疗后的临床疗效。结果 治疗1周后,两组患者的肺功能指标(用力肺活量、第1秒用力呼气容积、第1秒用力呼气容积与用力肺活量的比值、呼气峰值流速占正常预计值的百分比和6分钟步行试验距离)、动脉血氧分压、血氧饱和度、pH均高于治疗前,且观察组均高于对照组,差异有统计学意义(P<0.05),而呼吸频率、心率、动脉血二氧化碳分压、血清低氧诱导因子-1α、血清淀粉样蛋白A水平和临床症状评分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。观察组临床总有效率为85.37%,明显高于对照组的73.17%,但差异无统计学意义(P>0.05)。结论 布地奈德雾化吸入配合无创机械通气治疗可有效提高COPD并发呼吸衰竭老年患者的肺功能,改善动脉血气、生命体征和临床症状,减轻机体的氧化应激和炎症反应,值得临床使用。

补肺汤加减联合有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期并呼吸衰竭的价值

目的探讨中药补肺汤结合有创-无创序贯机械通气治疗慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭的临床效果。方法选取沭阳铭和医院在2020年1月-2021年12月收治的AECOPD并呼吸衰竭患者125例,按照双盲法将其随机分为研究组(n=63)和对照组(n=62),对照组采取有创-无创序贯机械通气治疗,研究组采取中药补肺汤结合有创-无创序贯机械通气治疗,比较两组治疗效果。结果研究组VAP发生率、病死率,再插管率低于对照组(P<0.05);研究组ICU入住时间,住院时间少于对照组(P<0.05);研究组治疗后的血气指标均优于治疗前,且与对照组比较差异显著(P<0.05);研究组肺功能指标优于对照组(P<0.05)。结论采取中药补肺汤结合有创-无创序贯机械通气治疗AECOPD并呼吸衰竭,效果肯定。

1例肺出血-肾炎综合征合并结核潜伏感染患者的护理体会

本文总结1例肺出血-肾炎综合征合并结核潜伏感染的护理经验,包括生命体征及心肝肾肺等重要脏器功能监测、重症监护室患者心理辅导、无创呼吸机使用护理、血浆置换相关护理、结核潜伏感染护理、营养支持护理、压力性损伤预防护理。

有创-无创序贯机械通气治疗重症肺炎合并呼吸衰竭患者的临床疗效评价

目的探讨有创-无创序贯机械通气治疗重症肺炎合并呼吸衰竭患者的临床疗效。方法选取2021年1月—2022年8月在本院就诊的60例重症肺炎合并呼吸衰竭患者为研究对象,并将其按照随机数字表法分为对照组和研究组,每组30例。两组中均采取常规治疗方案,在此基础上,对照组中开展有创机械通气,研究组中开展有创-无创序贯机械通气,在两组间对比总有效率、症状缓解时间、治疗时间、呼吸机相关性肺炎发生率,并在两组治疗前后对比血清炎症因子指标、肺通气功能指标、动脉血气分析指标及生活质量评分。结果研究组总有效率高于对照组,组间差异有统计学意义(P<0.05)。与对照组相比,研究组中咳嗽、咳痰、气促的缓解时间均更短,研究组在机械通气和住院两个项目上耗费的时间更短,研究组中关于呼吸机相关性肺炎的发生率更低(P<0.05)。治疗后,研究组中血清炎症因子各项指标的水平、PaCO_(2)均低于对照组;研究组中FEV1、FEV1/FVC、PaO_(2)、生活质量评分均高于对照组(P<0.05)。结论对于重症肺炎合并呼吸衰竭患者,有创-无创序贯机械通气可对患者的肺通气功能及动脉血气状况起到更好的改善作用,加快其症状缓解,缩短治疗时间,具有良好的疗效,有利于提升其生活质量,还可减少呼吸机相关性肺炎的发生,确保了机械通气安全性。

1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理

总结1例心源性脑梗死后出血转化合并心肾综合征病人应用无创呼吸机治疗的护理经验。护理要点:无创呼吸机辅助通气治疗的护理、液体及营养支持管理、静脉血栓的预防及处理、预防和控制感染、联合康复科制订渐进式康复方案、出院指导与随访。经过21 d的精心治疗和护理,病人病情稳定,顺利转回当地医院继续康复治疗。

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

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。