有创机械通气呼吸机依赖患者的治疗对策探讨

:,(1956),,E2mail:[e-mail],200011::14:14,11::,,,,R563.8AAnApproachtotheRemedialStrategyforMechanicalVentilationDependantPatientsWithInvasivePositivePressureVentilationWANGChunbao,YANGMin,XIONGJianfei,etal.ShanghaiSecondPeoplesHospital,Shanghai200011,ChinaAbstractObjective:Toinvestigatetheclinicalfeatures,causesandremedialstrategyofmechanicalventilationdependantin14patientswithinvasivepositivepressureventilation(IPPV).Methods:Fourteenpatientswhodepen2dedonmechanicalventilationandwithdrewsuccessfullywerereviewedretrospectively.Results:Fourteenpatientswhodependedonmechanicalventilationallsurvived,noneofthemnecessitatessecondintubationinoneweek.Themaincausesofdependingonmechanicalventilationweremalnutrition,pulmonaryandcardiacinsufficiency,andmentaldependant.Conclusion:SuccesswithdrawalofIPPVdependsonthephysician’sskilltojudgetheoccasion,andalsocloselyrelatedtoprimarydiseases,nutritionalstatusandpulmonaryfunctionandsoon.Reinforcetheetio2logicaltreatmentandtakecomprehensivemeasureswhichbenefittowithdrawalofventilatormayenhancethesuc2cessrateoftreatingrespiratoryfailure.KeywordsRespiratoryfailureMechanicalventilationMechanicalventilationdependant,,(),,20001200412514,,5104,17,16.35%,3,2,114(9,5),6185,73.9(chronicobstructivepulmonarydisease,COPD)11,2,1COPD1642143,2,2,16,5,31843d,25.7d,11(%)(d)750.028.9321.424.7214.322.517.121.017.118.0:,25/min,120/min,75200612210L/min,FiO240%,PaO260mmHg;1h,FiO240%,,;72h,,:(enteralnutri2tion,EN),(totalpar2enteralnutrition,TPN);(synchronizedintermittentmandatoryventilation,SIMV)(pressuresupportventila2tion,PSV),;,;,;,;;;;,;lu;lv,14,118,,,,[1]:,:,COPD,,,,,,,,,,::COPD,[2]50%,7(albumin,ALB)25.3g/L,0.33cm,,,,,,,,EN,TPN,[3],7ALB33.7g/L,0.51cm,,:2,1,,,,,1:SaO291.3%,PaO259.7mmHg,PaCO261.5mmHg,pH7.32,R2028/min,,O2CO2,:COPD,,,,,,,[1],,[4],,,:,,,,SaO2,,,,,SaO2,:,,,O2CO2,(61)852006122ECGBAD,,,,ST[6]ABBerrand19843199610108AD,4446,A152%,51046%37%,,,ABA,176%,51072%40%,AB,,BA,,,190%[7],1HaganPG,NienaberCA,IsselbacherEM,etal.Theinterna2tionalregistryofacuteaorticdissection(IRAD);newinsightsintoanolddisease.JAMA,2000,283:897.2MeszarosI,Morocz,J,SzlaviJ,etal.Epidemiologyandclinico2pathologyofaorticdissection.Chest,2000,117:1270.3ChirilloF,MarchioriMC,AndrioloL,etal.Outcomeof290patientswithaorticdissection:a122yearsmulticentreexperi2ence.EurheartJ,1990,11:311.4CarrelT,NguyenT,GysiJ,etal.AcutetypeBaorticdissec2tion:prognosisafterinitialconservativetreatmentandpredictivefactorforacomplicatedcourse.Schweiz,MedWochenschr,1997,127,1467.5NienaberCA,InceH,WeberF,etal.Emergencystent2graftplacementinthoracicaorticdissectionandevolvingrupture.JCardSurg,2003,18:464.6FossumE,AtaB,EritslandJ,etal.Aorticdissection:adiffer2entialdiagnosisinpatientswithchestpainandECGchanges.TidsskrNorLaegeforen,2003,123:2430.7MarsaleseDL,MoodieDS,Lytle,etal.CysticmedicalnecrosisoftheaortainpatientswithoutMarfan’ssyndrome:surgicalout2comeandLong2termfollow2up.JAmCollCardiol,1990,16:68.(20062012252006202218)(58),,,,,,SaO2,,,,,,:,,;,,130min,,,;,,,;,,,COPD,[5],,,;,(non2invasivepositivepressureventilation,NIP2PV),,14,,,,,,,,,1..:,2002.142147.2..,2003,10:4.3..,2004,1:470.4..:,2000.402404.5ScholsAM.Nutritioninchronicobstructivepulmonarydisease.CurrOpinPulmMed,2000,6:110.(20052082182005210219)162006122