Analysis of the Effect of Non-Invasive Positive Pressure Ventilation in Emergency Treatment of Severe Bronchial Asthma with Respiratory Failure

Objective:This study aims to evaluate the clinical efficacy of non-invasive positive pressure ventilation(NIPPV)in patients with severe bronchial asthma combined with respiratory failure.Methods:90 patients with severe bronchial asthma combined with respiratory failure between September 2022 and December 2023 were selected for the study and randomly divided into the experimental group(NIPPV-assisted treatment)and the control group.The differences between the two groups were compared in terms of total effective rate of treatment,days of clinical symptom disappearance,days of hospitalization,lung function indexes,incidence of adverse reactions,and quality of life.Results:Patients in the experimental group had a significantly higher total effective rate of treatment(97.78%)than the control group(75.56%).In terms of pulmonary function indexes,patients in the experimental group showed significant improvement after treatment,especially the increase in forced expiratory volume and forced vital capacity,while these improvements were not as obvious in the control group.In addition,the incidence of adverse reactions was significantly lower in the experimental group than in the control group,suggesting that the application of NIPPV is relatively safe.Quality of life assessment also showed that patients in the experimental group had significantly better quality of life than the control group after treatment.Conclusion:This study demonstrated the effectiveness of NIPPV as an adjunctive treatment for severe bronchial asthma combined with respiratory failure.NIPPV can improve lung function,reduce the incidence of adverse effects,increase the overall effectiveness of the treatment,and contribute to the improvement of patients'quality of life.Therefore,NIPPV should be regarded as an effective and safe treatment in clinical management,especially in patients with severe bronchial asthma combined with respiratory failure,where its application has potential clinical significance.

Effects of pulmonary surfactant combined with noninvasive positive pressure ventilation in neonates with respiratory distress syndrome

BACKGROUND Neonatal respiratory distress syndrome(NRDS)is one of the most common diseases in neonatal intensive care units,with an incidence rate of about 7%among infants.Additionally,it is a leading cause of neonatal death in hospitals in China.The main mechanism of the disease is hypoxemia and hypercapnia caused by lack of surfactant AIM To explore the effect of pulmonary surfactant(PS)combined with noninvasive positive pressure ventilation on keratin-14(KRT-14)and endothelin-1(ET-1)levels in peripheral blood and the effectiveness in treating NRDS.METHODS Altogether 137 neonates with respiratory distress syndrome treated in our hospital from April 2019 to July 2021 were included.Of these,64 control cases were treated with noninvasive positive pressure ventilation and 73 observation cases were treated with PS combined with noninvasive positive pressure ventilation.The expression of KRT-14 and ET-1 in the two groups was compared.The deaths,complications,and PaO_(2),PaCO_(2),and PaO_(2)/FiO_(2)blood gas indexes in the two groups were compared.Receiver operating characteristic curve(ROC)analysis was used to determine the diagnostic value of KRT-14 and ET-1 in the treatment of NRDS.RESULTS The observation group had a significantly higher effectiveness rate than the control group.There was no significant difference between the two groups in terms of neonatal mortality and adverse reactions,such as bronchial dysplasia,cyanosis,and shortness of breath.After treatment,the levels of PaO_(2)and PaO_(2)/FiO_(2)in both groups were significantly higher than before treatment,while the level of PaCO_(2)was significantly lower.After treatment,the observation group had significantly higher levels of PaO_(2)and PaO_(2)/FiO_(2)than the control group,while PaCO_(2)was notably lower in the observation group.After treatment,the KRT-14 and ET-1 levels in both groups were significantly decreased compared with the pre-treatment levels.The observation group had a reduction of KRT-14 and ET-1 levels than the control group.ROC curve analysis showed that the area under the curve(AUC)of KRT-14 was 0.791,and the AUC of ET-1 was 0.816.CONCLUSION Combining PS with noninvasive positive pressure ventilation significantly improved the effectiveness of NRDS therapy.KRT-14 and ET-1 levels may have potential as therapeutic and diagnostic indicators.

Effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia

Objective: To discuss the effect of lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation on the blood gas results and systemic state of patients with COPD complicated by severe pneumonia. Methods: A total of 68 patients with COPD complicated by severe pneumonia who were treated in the hospital between November 2015 and April 2017 were collected, retrospectively analyzed and then divided into the group A (n=35) who received noninvasive positive pressure ventilation and the group B (n=33) who received lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation. The differences in arterial blood gas and serum index levels were compared between the two groups before and after treatment. Results: Before treatment, there was no statistically significant difference in arterial blood gas index levels as well as serum contents of inflammatory mediators, stress hormones and myocardial enzyme spectrum indexes between the two groups. After treatment, arterial blood gas indexes PH and PaO2 levels of group B were higher than those of group A;serum inflammatory mediators HMGB1, PCT and hs-CRP contents were lower than those of group A;serum stress hormones Cor, AngⅠ and AngⅡcontents were lower than those of group A;serum myocardial enzyme spectrum indexesα-HBDH and cTn-Ⅰ contents were lower than those of group A. Conclusion: Lung lavage via fiber bronchoscope combined with non-invasive positive pressure ventilation can effectively optimize the arterial blood gas levels, reduce systemic inflammatory stress state and protect the myocardial function of patients with COPD complicated by severe pneumonia.

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.

Sleep Quality for Patients Receiving Noninvasive Positive Pressure Ventilation and Nasal High-Flow Oxygen Therapy in an ICU: Two Case Studies

Aim: The purpose of this case study was to examine the sleep quality of patients receiving noninvasive positive pressure ventilation (NPPV) or nasal high-flow oxygen therapy (NHF) in an intensive care unit and to investigate what types of nursing support are offered to such patients. Methods: We examined one patient each for NPPV and NHF. Polysomnography (PSG), review of the patient charts, and semi-structured interviews were used to collect the data for analysis. Results: Patients treated with NPPV or NHF demonstrated a noticeable reduction in deep sleep, with most of their sleep being shallow. Their sleep patterns varied greatly from those of healthy individuals. These results suggest that, in addition to experiencing extremely fragmented sleep, sleep in these patients was more likely to be interrupted by nursing interventions, such as during auscultation of breath sounds. Furthermore, it was revealed that “anxiety or discomfort that accompanies the mask or air pressure” in patients treated with NPPV and “discomfort that accompanies the nasal cannula or NHF circuit” in patients treated with NHF may be primary causes of disrupted sleep. Our results suggest a need for nursing care aimed at improving sleep quality in patients treated with NPPV or NHF.

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.

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 on Respiratory Medicine Treatment of Chronic Obstructive Pulmonary Disease Combined with Respiratory Failure

Objective:To explore the respiratory medicine treatment methods for treating chronic obstructive pulmonary disease(COPD)combined with respiratory failure.Methods:70 cases of COPD patients with combined respiratory failure admitted to our hospital from January 2021 to January 2023 were selected as the study subjects,and randomly divided into the control group and the experimental group,each with 35 cases.The control group received only conventional treatment,and the experimental group received non-invasive positive pressure ventilation,and the treatment effects and changes in the levels of IL-18,hs-CRP,and CES2 inflammatory factors were observed and evaluated in the two groups.Results:There was no significant difference between the general data of the two groups(P>0.05);after treatment,the total effective rate of clinical efficacy of the observation group(91.43%)was significantly higher than that of the control group(71.43%),and the difference showed a significant correlation(P<0.05);after treatment,the level of inflammatory factor of the observation group was significantly reduced compared with that of the control group,and the difference showed a highly significant correlation(P<0.001).Conclusion:The non-invasive positive pressure ventilation treatment program significantly improves the therapeutic effect,effectively controls the level of inflammatory factors,and improves the health status of patients when dealing with patients with chronic obstructive pulmonary disease accompanied by respiratory failure,showing a good clinical application prospect.

Need for oxygen therapy and ventilatory support in premature infants in a hospital in Southern Brazil

BACKGROUND Prematurity in newborns is a condition that is associated with worse hospital outcomes when compared to birth to term.A preterm infant(PI)is classified when gestational age(GA)<37 wk.AIM To analyze prognostic indicators related to the use of oxygen therapy,noninvasive ventilation(continuous positive airway pressure)and mechanical ventilation(MV)in PI.METHODS This is a retrospective cohort.The sample was composed of PIs from a private hospital in southern Brazil.We included neonates with GA<37 wk of gestation in the period of January 1,2018 to December 31,2018.For data collection,electronic records were used in the Tasy Philips^(TM)system,identifying the variables:maternal age,type of birth,prenatal information,GA,Apgar score,birth weight,neonatal morbidities,vital signs in the 1st hour at birth,need for oxygen therapy,continuous positive airway pressure and MV,hospitalization in the neonatal intensive care unit,length of stay and discharge or death.RESULTS In total,90 PI records were analyzed.The median(p25-p75)of GA was 34.0(31.9-35.4)wk,and there were 45(50%)males.The most common morbidity among PIs was the acute respiratory discomfort syndrome,requiring hospitalization in the neonatal intensive care unit in 76(84.4%)cases.The utilization rate of oxygen therapy,continuous positive airway pressure and MV was 12(13.3%),37(41.1%)and 13(14.4%),respectively.The median(p25-p75)length of stay was 12.0(5.0-22.2)d,with 10(11.1%)deaths.A statistical association was observed with the use of MV and GA<28 wk,lower maternal age,low birth weight,Apgar<8 and neonatal deaths.CONCLUSION The identification of factors related to the need for MV in prematurity may help in the indication of a qualified team and technologies to promptly meet the unforeseen events that may occur after birth.

无创正压通气治疗急性肺损伤/急性呼吸窘迫综合征的观察

目的 评价无创正压通气 (NPPV)治疗急性肺损伤 (ALI) /急性呼吸窘迫综合征 (ARDS)患者的临床效果。方法 对 18例ALI/ARDS患者实施NPPV治疗结果进行回顾性总结 ,分析NPPV治疗前后动脉血氧分压 /吸氧浓度 (PaO2 /FiO2 )、呼吸频率 (RR)和心率 (HR)的变化。结果 NPPV治疗成功率为 5 5 6 % (10 / 18) ,8例NPPV治疗失败患者中 7例改用气管插管有创通气 ,总死亡率为 33 3% (6 / 18)。NPPV成功组 5 0 % (5 / 10 )为ALI患者 ,治疗后 1～ 2hPaO2 /FiO2 、RR和HR较治疗前有显著改善。NPPV失败组均为ARDS患者 ,治疗后 1～ 2hPaO2 /FiO2 、RR和HR无明显变化。结论 NPPV对部分ALI/ARDS患者是有效的支持治疗手段 ,尤其是ARDS早期的ALI阶段可考虑选用NPPV。如NPPV治疗失败 ,应及时转换为气管插管有创通气。

无创正压通气治疗AECOPD合并Ⅱ型呼吸衰竭的临床研究

目的探讨无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭的疗效。方法36例AECOPD合并中-重度Ⅱ型呼吸衰竭患者随机分为对照组和试验组。在常规治疗的基础上,对照组予低流量吸氧(2L/min),试验组接受BiPAP呼吸机无创通气治疗。于治疗前、治疗后2h及24h分别记录心率(HR)、呼吸(RR)、SpO2%及动脉血气指标(pH、PaCO2、PaO2)。结果NPPV通气治疗2h和24h后,试验组pH、SpO2和PaO2较治疗前明显升高(P<0.05),HR、RR和PaCO2较治疗前显著下降(P<0.05),且各项指标也明显优于同期对照组(P<0.05)。结论无创正压通气对AECOPD合并中-重度Ⅱ型呼吸衰竭具有较好的即时效应,可作为其首选的通气治疗手段。

无创正压通气患者发生鼻面部压疮危险因素的回顾性分析

目的:探讨分析无创正压通气(non-invasive positive pressure ventilation,NPPV)患者的鼻面部压疮发生情况及相关危险因素,为制定针对性的预防护理措施提供有效依据。方法:采用1∶1的病例–对照研究方法,通过查阅电子病历和护理记录收集患者在一般人口学特征、营养和疾病一般状况、无创正压通气使用情况以及鼻面部压疮发生情况等资料,采用Logistic回归性分析探讨影响持续无创正压通气患者鼻面部压疮发生的危险因素。结果:173名NPPV患者中发生鼻面部压疮的患者为48例(27.7%),其中Ⅰ期压疮为17例(9.8%),Ⅱ期压疮为30例(17.3%),Ⅲ期压疮为1例(0.6%);Logistic回归分析结果显示,年龄、Glasgow评分、SA S评分、血清白蛋白量、Pa O2水平、面部水肿情况、NPPV使用方式、使用NPPV总时间、使用减压保护贴、糖尿病低血压、使用类固醇类药物和使用心血管活性药物是持续无创正压通气患者发生鼻面部压疮的影响因素。结论:鼻面部压疮是持续无创正压通气患者的常见并发症,临床护士可根据患者的具体情况及相关影响因素进行预防性护理,避免鼻面部压疮的发生。

无创正压通气治疗急性呼吸衰竭失败的相关因素探讨

目的 研究无创正压通气 (NPPV)治疗急性呼吸衰竭 (ARF)失败的相关因素 ,探讨NPPV治疗失败需转换为有创通气的时机。方法 对 74例由各种病因所致ARF接受NPPV治疗患者根据治疗结果分为NPPV失败组和NPPV成功组 ,比较两组患者各项指标变化 ,分析与NPPV治疗失败相关的因素。结果 NPPV治疗失败 2 2例 (2 9 7% )。入院初NPPV失败组的呼吸频率 (RR)和心率 (HR)增快 ,动脉血二氧化碳分压 (PaCO2 )升高和pH下降 ,与NPPV成功组比较差异有显著性 (P <0 0 5 )。Logistic回归分析显示 ,RR >30次 /min ,HR >130次 /min ,PaCO2 >6 0mmHg ,pH <7 30是影响NPPV失败的相关因素。NPPV成功组治疗后 1～ 6h动脉血氧分压 (PaO2 )明显改善 ,与治疗前比较差异显著 (P <0 0 5 )。NPPV失败组治疗后 1～ 6h动脉血气与治疗前比较无明显改善。结论 ARF患者显著异常的RR、HR、PaCO2 和pH是与NPPV治疗失败相关的因素。NPPV治疗初期 (1～ 6h)动脉血气有无显著改善亦可作为预测NPPV治疗成功与否的指标。NPPV治疗失败时及时改用有创通气可降低病死率 ,改善预后。

无创正压通气治疗慢性阻塞性肺疾病急性加重并呼吸衰竭的临床应用研究

目的评价无创正压通气(NPPV)治疗慢性阻塞性肺疾病急性加重期(AECOPD)并呼吸衰竭的临床疗效,并对其使用方法进行分析。方法将57例AECOPD并呼吸衰竭患者随机分为两组,治疗组29例,在常规治疗的基础上予以NPPV治疗;对照组28例仅予以常规治疗。观察指标包括动脉血气分析、呼吸频率、心率、住院天数及气管插管率。结果治疗组患者动脉血酸碱度(pH)、氧分压(PaO2)、二氧化碳分压(PaCO2)、呼吸频率、心率比对照组明显改善(P<0.05)。治疗组与对照组平均住院天数分别为11±6天、19±7天(P<0.05),气管插管率分别为6.90%、32.14%(χ2=13.8,P<0.01),病死率分别为3.44%、10.71%(χ2=5.23,P<0.05)。结论 NPPV治疗COPD呼吸衰竭疗效确切,可降低患者病死率、气管插管率及住院天数。

急性左心衰竭患者无创正压通气中吗啡的作用

目的观察吗啡对急性左心衰竭(ALVF)患者无创正压通气(NPPV)的影响。方法15例应用NPPV的急性左心衰患者,常规药物治疗中,比较吗啡治疗前后,动脉血气分析(PaO2、PaCO2、SaO2)、心率(HR)、平均动脉血压(MAP)、呼吸频率(RR)、呼气潮气量(VT)、分钟通气量(VE)和通气依从性的变化。结果本组急性左心衰竭患者治疗有效率87%。吗啡治疗后无创通气依从性明显提高。治疗后3hHR、RR显著降低(P<0.001),MAP稳定;PaO2显著增高(P<0.001),PaCO2显著降低(P<0.05);呼吸机VE降低(P<0.001),呼气VT变化不明显(P>0.05)。结论吗啡改善ALVF患者NPPV治疗依从性,NPPV提高吗啡的安全性。

Ⅳ级慢性阻塞性肺疾病患者家庭无创通气的疗效观察及护理

目的探讨家庭无创机械通气治疗Ⅳ级COPD的观察和护理。方法收集我院67例Ⅳ级COPD病人临床资料为研究对象,分为长程家庭氧疗组(A组)和家庭无创通气组(B组),治疗过程中观察动脉血气、呼吸频率、心率和末梢氧饱和度,平均每年急性加重次数、住院次数、住院时间、住院费用。结果治疗后家庭无创通气组PaCO2降低、PaO2上升,与长程家庭氧疗组相比差异有显著意义(P<0.05)。平均每年急性加重次数、住院次数、住院时间、住院费用下降,与长程家庭氧疗组相比差异有显著意义(P<0.05)。结论家庭无创机械通气治疗Ⅳ级COPD患者效果良好,护士精心指导和家庭护理是关键。

经鼻高流量氧疗治疗急性左心衰竭的临床疗效分析

目的对比经鼻高流量氧疗(high-flow nasal cannula oxygen therapy, HFNC)和无创正压通气(non-invasive positive pressure ventilation, NPPV)治疗急性左心衰竭的疗效,探讨HFNC治疗急性左心衰竭的可行性。方法选取2017年6月至2018年10月北京市海淀医院心脏重症监护室收治的急性左心衰竭患者52例,随机分为HFNC组和NPPV组,每组26例。比较两种通气方式治疗前后呼吸循环指标[呼吸频率(respiration rate, RR)、HR、PaO_2、PaCO_2、氧合指数]、气管插管率、呼吸困难和舒适度的差异。结果两组患者在治疗后呼吸循环指标较治疗前均明显改善(P<0.05);治疗后两组患者呼吸循环指标及气管插管率的比较,差异均无统计学意义(P>0.05);HFNC组的治疗舒适度和耐受性明显优于NPPV组(P<0.05)。结论对于急性左心衰竭的治疗,HFNC与NPPV疗效相似,且HFNC具有更好的治疗舒适性和耐受性,是临床治疗急性左心衰竭新的呼吸支持方式。

BiPAP治疗慢性阻塞性肺病合并肺性脑病的临床观察

[目的]探讨无创正压通气(NPPV)对慢性阻塞性肺疾病急性加重(AECOPD)合并肺性脑病的治疗作用。[方法]应用经鼻(面)罩双水平气道正压(BiPAP)呼吸机对40例AECOPD伴肺性脑病患者在常规治疗同时进行无创通气治疗。观察治疗前及治疗后2 h、48 h的动脉血气及临床变化。[结果]40例患者5例死亡,其余患者血气分析及临床症状明显改善,PH值升高(P﹤0.05),PaCO2水平降低(P﹤0.05),PaO2水平升高,病人意识改善。[结论]无创正压通气对AECOPD并肺性脑病患者的疗效肯定。

低压力水平，BiPAP治疗AECOPD合并Ⅱ型呼吸衰竭的临床研究

目的探讨低压力水平BIPAP在慢性阻塞性肺疾病急性加重期（AECOPD）并Ⅱ型呼吸衰竭患者治疗中的有效性和安全性。方法对40例AECOPD并Ⅱ型呼吸衰竭的住院患者在常规抗感染、扩张气道、止咳、祛痰及适当应用糖皮质激素基础上给予尽可能低的压力支持水平（维持潮气量4—7ml／kg，同时SaO2〉90％的最低IPAP，EPAP≤5cmH2O）的BIPAP治疗；通过观察患者通气前后的动脉血气（pH、PaO2、PaCO2、SaO2）及呼吸频率的变化判断临床疗效。结果40例AECOPD并Ⅱ型呼吸衰竭患者中，经面罩BiPAP治疗后34例患者动脉血气、呼吸频率指标得到改善，pH、PaO2、SaO2较入院时明显升高，PaCO2和呼吸频率明显降低，且差异有显著性意义（P〈0．05）。结论BIPAP治疗可以改善AECOPD并Ⅱ型呼吸衰竭患者的生命体征及动脉血气指标，帮助此类患者减轻呼吸肌疲劳，防止呼吸衰竭进一步加重，并减少气管插管率，是治疗慢性阻塞性肺疾病急性加重期并Ⅱ型呼吸衰竭患者经济有效的方法；低压力支持水平（维持潮气量4～7ml／kg，同时SaO2〉90％的最低IPAP，EPAP≤5cmH2O）的BIPAP治疗成功率与更高压力支持水平患者成功率相同，且患者人机协调性更好，依从性、耐受性更好，副作用更少，更加安全。

具有高效过滤和恒定泄气量功能的无创正压通气面罩研制及功能测试

目的研发一种具有高效过滤和恒定泄气量功能(EFCL)的无创正压通气(NPPV)面罩,并探讨其有效性。方法进行EFCL面罩发明设计,并完成其产品制造。将20例健康人作为研究对象,根据不同面罩类型分为两组:试验组采用EFCL面罩;对照组采用传统NPPV面罩和侧孔型呼气阀的组合。每个研究对象均采用试验组和对照组的前后交叉研究。在标准化试验条件及呼气气道正压(EPAP)为5、10 cm H_(2)O条件下,监测两组面罩内呼气末二氧化碳分压(Pet CO_(2));吸气气道正压(IPAP)从5 cm H_(2)O逐步递增至10、15、20 cm H_(2)O时,监测两组各节点呼气阀泄气量;评价两组面罩操作性和舒适性。结果在相同EPAP水平(5 cm H_(2)O或10cm H_(2)O),试验组面罩内Pet CO_(2)均显著低于对照组(均P<0.05);IPAP从5 cm H_(2)O逐步递增至20 cm H_(2)O时,试验组呼气阀泄气量维持相对恒定,对照组呼气阀泄气量则随IPAP压力增高而增加。两组面罩的操作性、舒适性均具有较高的满意率和一致性。结论EFCL面罩具有高效过滤和恒定泄气量的功能,为降低NPPV面罩应用中的交叉感染风险提供新方法。