白春學(xué)-呼吸衰竭[1]

1、1Bai ChunxueDepartment of Respiratory diseaseZhongshan HospitalFudan UniversityChapter 7復(fù)旦呼研所復(fù)旦呼研所2Respiratory failure Acute respiratory distress syndrome(ARDS)dyspnea Hypoxemiahypercapnia Respiratory Support Mechanical ventilation Positive end-expiratory pressure (PEEP) 復(fù)旦呼研所復(fù)旦呼研所3Chapter 7Type I、I

2、I Respiratory Failure Centrol、 Non-Centrol Respiratory Failure Acute & Chronic Respiratory Failure 復(fù)旦呼研所復(fù)旦呼研所4Bai Chun-XueDepartment of Respiratory diseasesZhongshan Hospital復(fù)旦呼研所復(fù)旦呼研所5respiratory dysfunction resulting in abnormalities of oxygenation or ventilationimpair or threaten the function

3、 of vital organs 復(fù)旦呼研所復(fù)旦呼研所6Type IParenchymaEdemaVascular diseaseChest Wall & Pleural diseaseType IIAirway obstructionNeuromuscular disease復(fù)旦呼研所復(fù)旦呼研所7hypoxemiaPerfusionDiffusionVentilationCO2CO2O2O2Clinical FindingsClinical Findings復(fù)旦呼研所復(fù)旦呼研所8PAO2 ，P ACO2（kPa)hypercapniahypercapniaCO2O2Clinical

4、FindingsClinical Findings復(fù)旦呼研所復(fù)旦呼研所9 cyanosis, restlessness confusion, anxiety, delirium tachypnea, tachycardia hypertension, cardiac arrhythmias tremor 復(fù)旦呼研所復(fù)旦呼研所10Dyspnea and headache peripheral and conjunctiva hyperemiahypertension, tachycardia,tachypneaimpaired consciousnesspapilledema, and aste

5、rixis 復(fù)旦呼研所復(fù)旦呼研所11PaO26.66 kPa復(fù)旦呼研所復(fù)旦呼研所12specific therapy directed toward the underlying disease; respiratory supportive care directed toward the maintenance of adequate gas exchange; general supportive care. 復(fù)旦呼研所復(fù)旦呼研所13Nonventilatory aspects Ventilatory aspects 復(fù)旦呼研所復(fù)旦呼研所14 SaO2 of 90% (PaO2 abou

6、t 60 mm Hg). Hypoxemia in patients with obstructive airway disease is usual easily corrected by using low-flow oxygen by nasal cannula (13 L/min) or Venturi mask (2428%). Higher concentrations of oxygen are necessary to correct hypoxemia in patients with ARDS, pneumonia, and other parenchymal lung d

7、iseases. 復(fù)旦呼研所復(fù)旦呼研所15白春學(xué)白春學(xué),等等. 應(yīng)用國(guó)產(chǎn)呼吸器經(jīng)鼻面罩治療慢性阻塞性肺病應(yīng)用國(guó)產(chǎn)呼吸器經(jīng)鼻面罩治療慢性阻塞性肺病所致呼吸衰竭所致呼吸衰竭9例報(bào)告例報(bào)告. 上海醫(yī)學(xué)上海醫(yī)學(xué) 1993;16:102復(fù)旦呼研所復(fù)旦呼研所16Tracheal intubation Mechanical ventilation 復(fù)旦呼研所復(fù)旦呼研所17Hypoxemia which is not quickly reversed by supplemental oxygenAirway obstructionImpaired airway protectionInadequate han

8、dling of secretionsFacilitation of mechanical ventilation 18復(fù)旦呼研所復(fù)旦呼研所19ApneaAcute hypercapnia that is not quickly reversed by appropriate specific therapySevere hypoxemiaProgressive patient fatigue despite appropriate treatment20Assisted mechanical ventilation (AMV) or assist/control (A/C) Synchron

9、ized intermittent mandatory ventilation (SIMV) Pressure support ventilation (PSV)21Pressure control ventilation (PCV)Continuous positive airway pressure (CPAP) Positive end-expiratory pressure (PEEP)22Atelectasis of the centrolateral lung and overdistention of the intubated lung Barotrauma, manifest

10、ed by subcutaneous emphysema, pneumomediastinum, subpleural air cysts, pneumothorax, or systemic gas embolism23Subtle parenchymal lung injury Acute respiratory alkalosis Hypotension Ventilator-associated pneumonia, mortality rate of this disorder is about 5060% 24Nutrition Psychological and emotiona

11、l supportSkin care Meticulous avoidance of nosocomial infection and complications of tracheal tubes復(fù)旦呼研所復(fù)旦呼研所25Course & Prognosis 復(fù)旦呼研所復(fù)旦呼研所26Prognosis of acute respiratory failure caused by uncomplicated sedative or narcotic drug overdose is excellentAcute respiratory failure in patients with COPD who do not require intubation and mechanical ventilation has a good immediate prognosis Course & PrognosisCourse & Prognosis復(fù)旦呼研所復(fù)旦呼研所27ARDS associated with sepsis has an extremely poor prognosis, with mortality rates of about