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.

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.

正压通气联合氨溴索治疗重型新生儿肺炎临床效果研究

目的探讨双管鼻塞式持续呼吸道正压通气(CPAP)配合氨溴索雾化吸入治疗重型新生儿肺炎的临床效果及对血清可溶性白细胞介素-2受体(SIL-2R)、核转录因子κB(NF-κB)、降钙素原(PCT)水平的作用。方法选取2018年10月至2021年12月驻马店市中医院重型新生儿肺炎患儿98例,按随机数字表法分为观察组(n=49)、对照组(n=49)。常规治疗基础上,对照组予以双管鼻塞式CPAP,观察组采取双管鼻塞式CPAP配合氨溴索雾化吸入,均持续治疗5 d。对比两组疗效与治疗前、治疗5 d后血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、肺功能指标[呼气峰流速(PEF)、功能残气量(FRC)、潮气量(VT)]、血清SIL-2R、NF-κB、PCT、体液免疫功能[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]水平、支气管黏膜纤毛结构(动力蛋白臂缺失、复合纤毛、鳞状上皮化生、纤毛数量异常)情况。结果观察组治疗5 d后总有效率(93.88%)高于对照组,差异有统计学意义(χ^(2)=77.55%,P<0.05);经过5 d的治疗后,观察组的PaO_(2)、PEF、FRC、VT水平高于对照组,PaCO_(2)水平低于对照组,差异有统计学意义(t=9.227,4.141,6.360,5.093,5.116,P均<0.05);经过5 d的治疗后,观察组血清SIL-2R、NF-κB及PCT水平,IgG、IgM及IgA水平高于对照组,差异有统计学意义(t=11.231,17.612,15.826,3.984,2.712,3.154,P均<0.05);观察组治疗5 d后动力蛋白臂缺失、复合纤毛、鳞状上皮化生、纤毛数量异常人数比例低于对照组,差异有统计学意义(χ^(2)=4.438,4.405,5.539,7.127,P均<0.05)。结论双管鼻塞式CPAP联合氨溴索雾化吸入首次治疗重型新生儿肺炎,疗效确切,能有效改善动脉血气分析、肺功能,控制炎症反应,调节体液免疫功能,增强支气管黏膜纤毛功能。

单双肺气道压差值在双腔气管导管插管的定位效果观察

目的 探讨单双肺气道压差值(airway pressure differences between one lung and two lung ventilation,ΔP)指导双腔气管导管(double lumen tube,DLT)插管定位的效率及肺隔离效果。方法 选取2021年11月至2022年10月北京协和医院胸外科拟在单肺通气下手术的患者396例,患者随机分为纤维支气管镜(fiber optical bronchoscopy,FOB)组和ΔP组,每组198例,FOB组采用FOB定位DLT,ΔP组采用ΔP定位DLT。比较两组侧卧位后DLT调整时间、DLT插管时间、SpO_(2)及肺塌陷效果满意度。结果 396例患者中,男203例,女193例,年龄36~69岁,平均(56.8±4.8)岁。ΔP组侧卧位后DLT调整时间短于FOB组[(37.73±14.06)s比(51.76±15.74)s],差异有统计学意义(P<0.05);两组DLT插管时间、SpO_(2)、肺塌陷效果满意度的比较,差异均无统计学意义(P>0.05)。结论 ΔP具有操作时间短、较高DLT定位成功率和较好单肺通气肺塌陷效果等优势,尤其在FOB缺少时,ΔP可作为DLT插管定位的新方法。

经鼻双水平正压通气联合肺表面活性物质、布地奈德治疗新生儿呼吸窘迫综合征的近期疗效及对降钙素原、C-反应蛋白的影响

目的 探讨经鼻双水平正压通气联合肺表面活性物质、布地奈德治疗新生儿呼吸窘迫综合征的近期疗效及对降钙素原、C-反应蛋白的影响。方法 将福建医科大学附属龙岩第一医院2020年1月至2022年3月收治的62例新生儿呼吸窘迫综合征按随机数字表分为对照组和观察组,每组各31例,对照组新生儿采取经鼻双水平正压通气联合肺表面活性物质治疗,观察组新生儿采取经鼻双水平正压通气联合肺表面活性物质、布地奈德联合治疗,比较两组新生儿症状缓解时间、无创辅助通气时间及住院时间,治疗前及治疗24 h进行动脉血气指标检测,治疗前及治疗48 h采用酶联免疫吸附试验法(ELISA)进行血清C-反应蛋白和降钙素原检测,治疗48 h后进行临床疗效评价,记录并发症发生情况。结果 观察组新生儿症状缓解时间、无创辅助通气时间及住院时间分别为(17.52±4.66)h、(71.75±3.74)h、(13.56±3.35)d,均明显短于对照组(30.26±5.04)h、(96.72±4.06)h、(17.57±3.73)d,均P<0.05。观察组新生儿治疗后动脉血氧分压、氧合指数分别为(61.80±2.02)mm Hg、(268.38±15.66)mm Hg,明显高于治疗前(44.68±1.06)mm Hg、(100.20±8.74)mm Hg及对照组治疗后(55.45±1.86)mm Hg、(200.08±14.26)mm Hg,P<0.05,动脉二氧化碳分压为(40.40±1.24)mm Hg,明显低于治疗前(50.92±2.40)mm Hg及对照组治疗后(45.03±1.58)mm Hg,均P<0.05。观察组新生儿治疗后血清C-反应蛋白和降钙素原分别为(4.65±0.40)mg/L、(210.52±42.58)pg/mL,明显低于治疗前(7.57±0.62)mg/L、(510.58±48.62)pg/mL及对照组治疗后(5.81±0.42)mg/L、(290.88±45.14)pg/mL,均P<0.05。观察组临床总有效率为93.55%(29/31),明显高于对照组74.19%(23/31),差异有统计学意义,χ^(2)=6.389,P<0.05。观察组不良反应总发生率为6.45%(2/31),明显低于对照组25.81%(8/31),差异有统计学意义,χ^(2)=4.292,P<0.05。结论 经鼻双水平正压通气联合肺表面活性物质治疗新生儿呼吸窘迫综合征的基础上加用布地奈德能有效改善新生儿动脉血气指标,降低降钙素原、C-反应蛋白,缩短无创辅助通气时间及住院时间,降低并发症发生率。

不同PEEP通气对妇科腹腔镜手术患者认知功能的影响

目的探究不同水平呼气末正压(PEEP)通气对妇科腹腔镜手术患者认知功能的影响。方法选取90例妇科腹腔镜手术患者,按照抽签法分为A组与B组,每组45例。A组和B组气腹开始后头低脚高位5min时分别给予PEEP4cmH_(2)O和8cmH_(2)O进行通气。采用容量控制通气模式,记录其气腹后5min(T_(1))、气腹后15min(T_(2))、气腹后30min(T_(3))、气腹结束后5min(T_(4))的动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2)),计算其动态肺顺应性(Cdyn),并在术前1d与术后1周通过简易智力状态检查表(MMSE)评估两组患者的认知功能。结果B组PaO_(2)在T_(2)、T_(4)时明显高于A组,其PaCO_(2)在T_(2)、T_(3)、T_(4)时明显高于A组,差异有统计学意义(P<0.05)。B组Cdyn在T_(2)、T_(3)、T_(4)时明显大于A组,差异有统计学意义(P<0.05)。两组术前1d、术后1d的MMSE评分对比差异无统计学意义(P>0.05)。结论不同PEEP通气不会影响妇科腹腔镜手术患者的认知功能,但高水平PEEP更有利于改善患者的氧合状态。

BiPAP通气治疗慢性阻塞性肺疾病急性加重伴意识障碍的疗效观察

[目的]探讨无创双水平气道正压（BiPAP）通气治疗慢性阻塞性肺疾病急性加重（AECOPD）呼吸衰竭合并意识障碍患者的疗效。[方法]收集AECOPD呼吸衰竭合并意识障碍患者50例，随机分为治疗组（BiPAP治疗组）及对照组（常规治疗组），每组25例。观察治疗前后患者的生命体征及血气的变化。[结果]治疗24h后治疗组患者pH、PaO2、PaCO2及RR的改善明显好于对照组（P〈0．05）；治疗组及对照组的有效率分别为84％，68％，差异有统计学意义（P〈0．05）。治疗组治疗2～4h后血气指标明显改善（P〈0．05），24h后各项观察指标均显著好转（P〈0．05），至治疗结束时相对稳定。[结论]BiPAP是治疗AECOPD呼吸衰竭合并意识障碍患者的有效手段。初期BiPAP通气治疗应持续24h以上。

经鼻间歇正压通气辅助呼吸治疗新生儿呼吸窘迫综合征疗效观察

目的观察双鼻塞密闭环路方式经鼻间歇正压通气(NIPPV)辅助呼吸治疗新生儿呼吸窘迫综合征(NRDS)的临床效果。方法选择2016年2月至2020年2月东莞市长安医院收治的60例NRDS患儿进行研究,按照随机数表法分为观察组和对照组,每组30例。观察组在常规治疗基础上使用双鼻塞密闭环路方式NIPPV辅助通气治疗,对照组在常规治疗基础上使用经鼻持续气道正压通气(NCPAP)辅助通气治疗。比较两组患儿治疗3 d后的临床疗效、临床治疗情况,以及治疗前及治疗3 d后动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、呼吸频率(RR)、吸入氧浓度(FiO2)和并发症发生情况。结果治疗3 d后,观察组患儿的治疗总有效率为93.33%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);观察组患儿的无创通气撤机时间、总用氧时间及住院时间分别为(3.06±0.34)d、(4.91±0.51)d、(14.20±2.64)d,明显短于对照组的(4.11±0.50)d、(6.26±0.64)d、(17.36±2.17)d,差异均有统计学意义(P<0.05);治疗3 d后,观察组患儿的PaO2为(78.45±5.62)mm Hg,明显高于对照组的(70.12±4.75)mm Hg,PaCO2、RR、Fi O2分别为(37.30±3.14)mm Hg、(45.73±4.69)次/min、0.26±0.03,明显低于对照组的(43.51±3.68)mm Hg、(53.08±5.03)次/min、0.31±0.03,差异均有统计学意义(P<0.05);观察组患儿的并发症总发生率为13.33%,明显低于对照组的36.67%,差异有统计学意义(P<0.05)。结论双鼻塞密闭环路NIPPV辅助呼吸治疗NRDS短期效果显著,其可明显缩短无创通气撤机时间、总用氧时间及住院时间,改善血气指标,减少并发症发生,值得推广应用。

无创双水平气道正压通气联合纳洛酮治疗慢性阻塞性肺病急性加重期合并II型呼吸衰竭的疗效

目的:分析研究无创双水平气道正压通气联合纳洛酮治疗慢性阻塞性肺病急性加重期(AECOPD)合并II型呼吸衰竭的临床疗效。方法:治疗76例AECOPD合并II型呼吸衰竭的患者,其中常规治疗的患者38例(对照组),采用无创双水平气道正压通气联合纳洛酮治疗的患者38例(研究组)。统计分析两组的治疗效果。结果:对照组总有效率为81.58%,研究组总有效率为94.74%,两组比较差异有统计学意义(P<0.05)。治疗后,两组患者动脉血气的pH值、PaCO2、PaO2均得到明显的改善(P<0.05);且研究组的指标改善情况明显优于对照组(P<0.05)。结论:无创双水平气道正压通气联合纳洛酮治疗AECOPD合并II型呼吸衰竭,能够显著改善患者的血气指标,临床疗效确切,值得临床推广。

双向气道正压通气与不同流速模式同步间歇指令通气在心脏术后的比较研究

目的通过与两种不同流速模式(恒速和减速)同步间歇指令通气(SIMV)比较,评价双相气道正压通气(DuoPAP)在心脏术后应用的安全性和有效性。方法选取心内直视手术者40例,术后分别采用恒速、减速SIMV和DuoPAP模式通气,比较血流动力学、血气、呼吸力学参数及呼吸肌做功指标的变化。结果DuoPAP和减速SIMV的气道压峰值(Ppeak)、气道阻力(Raw)和吸气功(WI)较恒速型SIMV明显降低(p<0·01);前两种通气模式之间比较无统计学差异(p>0·05);三种通气模式的其他指标无统计学差异(p>0·05)。结论与传统的SIMV模式比较,DuoPAP模式对血流动力学、血气参数无明显影响,且与恒速型SIMV比较,可明显降低吸气时的Ppeak、Raw和WI,应用于心脏术后是安全、有效的。

双水平正压通气在新生儿呼吸窘迫综合征临床治疗中的应用

目的探究新生儿呼吸窘迫综合征(NRDS)采用双水平正压通气(Duo-PAP)治疗方法的临床疗效。方法随机抽取我院64例NRDS患儿,并随机分为观察组和对照组。观察组采用Duo-PAP联合PS(肺表面活性物质)方法治疗。对照组采用鼻塞持续气道正压通气(NCPAP)与PS联合治疗的方法。比较两组患儿的临床指标变化。结果治疗后,两组患儿Pa O2水平与Pa CO2水平(P<0.05,P<0.01)均有所改善,在治疗3 h和12 h后效果尤为显著。在治疗成功率上,虽然观察组比对照组稍高,但差异无统计学意义。结论治疗NRDS采用Duo-PAP方法可提高治疗效率,使呼吸窘迫症状有效改善。

双水平正压通气治疗急性心源性肺水肿的临床观察及护理

目的探讨双水平正压通气治疗急性心源性肺水肿的临床效果及针对性治疗护理的应用效果。方法选取急性心源性肺水肿患者84例随机分为观察组和对照组各42例,对照组患者采用吸氧、扩血管、强心等常规治疗及护理,观察组患者在对照组的基础上采用双水平正压通气及针对性治疗护理措施。比较2组患者治疗前后p(CO2)、p(O2)、血氧饱和度等血气指标的变化,并调查患者的满意度。结果双水平正压通气能降低急性心源性肺水肿患者p(CO2),升高p(O2)、血氧饱和度,观察组治疗后p(CO2)、p(O2)、血氧饱和度与对照组比较,差异具有统计学意义(P<0.05);观察组患者的护理满意度显著高于对照组,差异具有统计学意义(P<0.05)。结论双水平正压通气治疗急性心源性肺水肿的临床效果好,采用针对性治疗护理措施能提高患者的满意度。

Bi-PAP呼吸机在急性左心衰竭治疗中的应用体会

目的:探讨急性左心衰竭抢救中Bi-PAP呼吸机的应用经验。方法:35例经常规治疗不能改善症状及纠正低氧血症的急性左心衰竭患者,给予双水平正压通气(Bi-PAP)治疗,观察患者临床症状、体征及血气方面的变化。结果:35例患者使用Bi-PAP呼吸机后,症状和体征明显改善,心率(HR)、呼吸频率(RR)、收缩压(SBP)、氧分压(PaO2)、二氧化碳分压(PaCO2)及pH较治疗前好转。结论:急性左心衰竭患者尽早使用无创Bi-PAP呼吸机,可改善症状,提高抢救成功率,且使用方便,患者痛苦少。

P_(ET)CO_2和P_(peak)监测在双腔支气管导管插管中的应用

目的探讨非通气侧呼气末CO2分压(PETCO2)和通气侧气道峰压(Ppeak)联合监测用于左侧双腔支气管导管(L-DLT)插管定位的可行性。方法 60例胸腔镜择期手术患者,随机分为两组,每组30例:A组(普通听诊组):根据两肺分别行单肺通气时呼吸音的听诊情况调节插管深度定位;B组(PETCO2和Ppeak组):通过监测非通气侧呼气末CO2分压(PETCO2)和通气侧吸气峰压(Ppeak)的变化调整导管的位置。记录两组患者的插管定位时间、临床定位满意率和术后并发症发生率。结果与A组(126.53±19.14)s比较,B组患者插管定位时间(57.17±14.02)s明显缩短(p<0.01);与A组比较,B组患者术后并发症的发生率也明显降低(p<0.05);B组患者的临床定位满意率(83.3%)也显著高于A组(56.7%,p<0.05)。结论和传统听诊法相比,通过监测非通气侧PETCO2和通气侧Ppeak的变化定位时间短,定位满意率高,术后并发症的发生率降低。