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.

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.

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。

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。

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。

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。

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。

HFNC与NIPPV对AECOPD合并Ⅱ型呼吸衰竭患者的临床疗效观察

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。

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。

经鼻无创高频振荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中的应用

目的分析经鼻无创高频震荡通气联合经皮二氧化碳分压(TcPCO_(2))和经皮氧分压(TcPO_(2))监测在早产儿呼吸窘迫综合征中的应用。方法选择2019年10月至2021年10月收治的新生儿呼吸窘迫综合征无创呼吸支持治疗的早产儿80例,采用随机数字法分为改良组(经鼻无创高频震荡通气)和对照组(经鼻持续正压通气)。每组40例。2组均联合TcPCO_(2)和TcPO_(2)监测。观察2组通气0、6、12、24 h后的pH值、TcPCO_(2)/TcPO_(2)指标、无创通气时间、治疗失败转为气管插管机械通气率、并发症发生率及病死率。结果通气0 h,2组血液pH值、TcPCO_(2)、TcPO_(2)比较差异无统计学意义(P>0.05);与对照组比较,改良组通气6、12、24 h血液pH值、TcPO_(2)均明显升高,TcPCO_(2)均明显降低(P<0.05)。与对照组比较,无创通气时间和治疗失败转为气管插管机械通气率均明显降低(P<0.05)。2组气漏、腹胀、鼻部损伤、肺出血、感染性肺炎等并发症发生率比较差异无统计学意义(P>0.05)。对照组病死率为5.00%(2/40),改良组病死率为2.50%(1/40),差异无统计学意义(P>0.05)。结论经鼻无创高频震荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中应用价值较高,可改善患儿呼吸功能,降低气管插管机械通气率,且不会增加并发症的发生。

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。

无创气道正压通气下呼气末测算气道阻力和肺顺应性实验研究

目的采用呼气末压力短暂释放的方式,测算无创正压通气(non-invasive positive pressure ventilation,NPPV)条件下的气道阻力(R)和肺顺应性(C),并评估其测算精度。方法首先,将测算方法程序移植到NPPV呼吸机的控制器,设计基于主动模拟肺ASL5000的通气实验平台。然后,模拟正常成人(R=5 cmH_(2)O,C=50 mL/cmH_(2)O。1 cmH_(2)O=0.098 kPa)、急性呼吸窘迫综合征成人患者(R=10 cmH_(2)O,C=30 mL/cmH_(2)O)和慢性阻塞性肺疾病成人患者(R=20 cmH_(2)O,C=50 mL/cmH_(2)O)的R和C进行实验。结果测算所得R最大相对误差达到-12.67%,出现在对正常成人的测定;C最大相对误差达到17.37%,出现在对急性呼吸窘迫综合征成人患者的测定。采用均值配对双样本t检验法对每组测试数据进行分析,差异没有统计学意义(P>0.05)。结论实验所得R、C与在ASL5000上的设置值相一致。NPPV下呼气末R、C的测算方法具有良好的可行性,其实现与应用有助于呼吸机通气治疗的精准化和个体化。

针刺联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭患者疗效观察

目的观察针刺联合NIPPV治疗慢性阻塞性肺疾病(COPD)合并Ⅱ型呼吸衰竭对血气指标及血清胱抑素(Cys)C、β2-微球蛋白(MG)的影响。方法选取COPD合并Ⅱ型呼吸衰竭患者134例,按照随机抽签法将其分为对照组与试验组各67例。对照组在常规治疗基础上采用NIPPV进行治疗,试验组在对照组基础上联合针刺治疗。观察两组治疗前后中医证候积分、血气指标[血气酸碱度(pH)、氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(SpO_(2))]、肾损伤指标(Cys C、β2-MG)、炎性指标[血清白介素(IL)-8、肿瘤坏死因子(TNF)-α]水平变化,并比较治疗后肺功能[第1秒用力呼气容积占预计值百分比(FEV1%pred)、肺活量占预计值百分比(FVC%pred)、FEV1/FVC]差异。结果治疗后,两组患者各中医证候积分、PaCO_(2)、血清IL-8、TNF-α水平较治疗前均降低,且试验组低于对照组(P<0.05);两组患者pH、PaO_(2)、SpO_(2)较治疗前均升高,且试验组显著高于对照组(P<0.05);试验组FEV1%pred、FVC%pred、FEV1/FVC高于对照组,血清Cys C、β2-MG水平低于对照组(P<0.05),对照组血清Cys C、β2-MG水平与治疗前差异无统计学意义(P>0.05)。结论采用针刺法联合NIPPV治疗COPD合并Ⅱ型呼吸衰竭患者,通过抑制炎性反应,下调Cys C、β2-MG水平,可有效改善患者肺功能、血气参数,缓解临床症状。

无创正压通气治疗患者发生胃肠功能紊乱的列线图预测模型构建

目的 探讨无创正压通气(non-invasive positive pressure ventilation, NIPPV)治疗患者发生胃肠功能紊乱的危险因素,构建胃肠功能紊乱列线图预测模型,并验证其预测效果。方法 回顾性选取2019年1月-2023年1月于我院急诊ICU住院行NIPPV治疗的368例患者为研究对象,按照7∶3的比例随机分为建模集258例和验证集110例。根据患者ICU住院期间是否发生胃肠功能紊乱,将患者分为胃肠功能正常组和紊乱组。采用多因素logistic回归分析建立的胃肠功能紊乱列线图预测模型,并对该模型进行内部验证,评价其预测效能。结果 NIPPV治疗患者胃肠功能紊乱发生率为30.16%,其中以腹胀最为常见。最终纳入模型的预测变量为年龄、糖尿病、管饲、NIPPV模式、胃泌素、白蛋白、超敏C反应蛋白。建模集中,受试者工作特征曲线下面积为0.809,预测临界值为168分,敏感度为66.2%,特异度为80.7%,Hosmer-Lemeshow检验χ~2=3.949,P=0.862。验证集中,受试者工作特征曲线下面积为0.817,敏感度为67.6%,特异度为86.8%,Hosmer-Lemeshow检验χ~2=7.092,P=0.527。校正曲线均显示出良好的区分度及一致性。结论 本研究构建的NIPPV治疗患者胃肠功能紊乱的风险预警列线图模型具有较高的预测效能,可为临床ICU医护人员识别胃肠功能紊乱高危患者提供依据。

术后无创呼吸支持的研究进展

术后肺部并发症(PPCs)是指术后发生的呼吸系统并发症,主要包括呼吸道感染、呼吸衰竭、胸腔积液、肺不张、气胸、支气管痉挛及吸入性肺炎等。PPCs的发生与患者自身、手术和麻醉等因素密切相关,影响患者围术期康复及预后。无创呼吸支持(NRS)包括常规氧气疗法(COT)、无创正压通气(NPPV)、经鼻高流量(HFNC)氧疗等,通过改善肺部呼吸力学和满足氧气需求减少肺部并发症的发生。目前NRS已在重症监护病房(ICU)广泛应用,但其术后应用尚无共识。本文就近年来术后NRS应用的研究进展进行综述,包括NRS的模式、NRS在不同类型手术的应用和NRS在不同类型患者的应用等内容,为促进术后康复提供参考。