网站首页期刊介绍通知公告编 委 会投稿须知电子期刊广告合作联系我们
最新消息:
PetCO2监测评估重度呼吸性酸中毒COPD患者无创正压通气治疗的呼吸不良事件
作者:曹赋韬  崔羽  毛佳  范晓春  万方  潘卫宇  孙芸  屠苏 
单位:无锡市第二人民医院, 江苏 无锡 214000
关键词:慢性阻塞性肺疾病 无创正压通气 呼气末二氧化碳分压 呼吸不良事件 重度呼吸性酸中毒 
分类号:R563
出版年·卷·期(页码):2018·46·第十期(1136-1139)
摘要:

目的:研究呼气末二氧化碳分压(PetCO2)测定用于监测重度呼吸性酸中毒的慢性阻塞性肺疾病(COPD)患者接受无创正压通气(NPPV)治疗中呼吸不良事件的临床价值。方法:选择我院收治的重度呼吸性酸中毒的COPD患者60例,予NPPV治疗,同时行心电、脉搏氧饱和度(SpO2)和PetCO2监测,观察和比较患者初始治疗2 h内不同监测手段发现呼吸不良事件的发生情况。结果:NPPV初始治疗2 h内无死亡病例,共发现呼吸不良事件168次,通气不足、通气过度、窒息和低氧血症分别为57例、37例、34例和40例。与心电及SpO2监测相比,PetCO2在监测通气不足、通气过度、窒息和低氧血症及总的不良事件方面明显更优(P<0.05)。60例重度呼吸性酸中毒COPD患者NPPV治疗有效52例,有效率86.67%。结论:在接受NPPV治疗的重度呼吸性酸中毒COPD患者监测中,与常规心电及SpO2监测相比,PetCO2对呼吸不良事件具有更高的监测发现价值。

参考文献:

[1] NI Y N,WANG T,YU H,et al.The effect of sedation and/or analgesia as rescue treatment during noninvasive positive pressure ventilation in the patients with interface intolerance after extubation[J].BMC Pulm Med,2017,17(1):125.
[2] MARCHIONI A,CASTANIERE I,TONELLI R,et al.Ultrasound-assessed diaphragmatic impairment is a predictor of outcomes in patients with acute exacerbation of chronic obstructive pulmonary disease undergoing noninvasive ventilation[J].Crit Care,2018,22(1):109.
[3] 中华医学会呼吸病学分会慢性阻塞性肺疾病学组.慢性阻塞性肺疾病诊治指南(2007年修订版)[J].中华结核和呼吸杂志,2007,30(1):8-17.
[4] VITACCA M,VISCA D,SPANEVELLO A.Care-related intervention in rehabilitative pneumology:pulmonary rehabilitation in chronicobstructive broncopneumopathies(COPD) can benefit from a multidisciplinary approach?[J].G Ital Med Lav Ergon,2018,40(1):37-41.
[5] CRINER G J,DREHER M,HART N,et al.COPD home oxygen therapy and home mechanical ventilation:improving admission-free survival in persistent hypercapnic COPD[J].Chest,2018,153(6):1499-1500.
[6] GADRE S K,DUGGAL A,MIRELES-CABODEVILA E,et al.Acute respiratory failure requiring mechanical ventilation in severe chronic obstructive pulmonary disease(COPD)[J].Medicine (Baltimore),2018,97(17):e0487.
[7] DUIVERMAN M L.Noninvasive ventilation in stable hypercapnic COPD:what is the evidence?[J].ERJ Open Res,2018,4(2):2012-2018.
[8] ABROUG F,OUANES-BESBES L,HAMMOUDA Z,et al.Noninvasive ventilation with helium-oxygen mixture in hypercapnic COPD exacerbation:aggregate meta-analysis of randomized controlled trials[J].Ann Intensive Care,2017,7(1):59.
[9] NILIUS G,KATAMADZE N,DOMANSKI U,et al.Non-invasive ventilation with intelligent volume-assured pressure support versus pressure-controlled ventilation:effects on the respiratory event rate and sleep quality in COPD with chronic hypercapnia[J].Int J Chron Obstruct Pulmon Dis,2017,12(3):1039-1045.
[10] 阚海峰,陈龙,杨志云.持续气道正压通气治疗对中重度阻塞性睡眠呼吸暂停低通气综合征患者肝纤维化标志物的影响[J].东南大学学报(医学版),2015,34(1):113-115.
[11] YANG H,XIANG P C,ZHANG E M,et al.Is hypercapnia associated with poor prognosis in chronic obstructive pulmonary disease? A long-term follow-up cohort study[J].BMJ Open,2015,5(12):e008909.
[12] WALENGA R L,LONGEST P W,KAVIRATNA A,et al.Aerosol drug delivery during noninvasive positive pressure ventilation:effects of intersubject variability and excipient enhanced growth[J].J Aerosol Med Pulm Drug Deliv,2017,30(3):190-205.
[13] THIAGO D C,PAULA R S,de LÚBIA C M,et al.Performance of noninvasive ventilation in acute respiratory failure in critically ill patients:a prospective,observational,cohort study[J].BMC Pulm Med,2015,15(11):144.
[14] NOUSHEEN A,NADEEM A R.Application of BiPAP through Endotracheal Tube in Comatose Patients with COPD Exacerbation[J].Pak J Med Sci,2017,33(6):1444-1448.
[15] RESTREPO R D,NUCCIO P,SPRATT G,et al.Current applications of capnography in non-intubated patients[J].Expert Rev Respir Med,2014,8(5):629-639.
[16] CNOWAY A,DOUGLAS C,SUTHERLAND J.Capnography monitoring during procedural sedation and analgesia:a systematic review protocol[J].Syst Rev,2015,4(7):92.

服务与反馈:
文章下载】【发表评论】【查看评论】【加入收藏
提示:您还未登录,请登录!点此登录
您是第 235896 位访问者


 ©《现代医学》编辑部
联系电话:025-83272479;83272481
电子邮件: xdyx@pub.seu.edu.cn

苏ICP备09058541