摘要
目的探讨影响面罩通气治疗慢阻肺呼吸衰竭的技术因素。方法根据呼吸机性能、面罩特性、通气模式及通气参数的调节分３期，比较面罩通气的效果和副作用。结果面罩的材料、气垫的充盈度、固定方法可影响患者的舒适度和通气的密闭性。压力支持通气（ＰＳＶ）的同步性好、有效通气量高。呼吸中枢兴奋性低下或呼吸肌严重疲劳时，需改用辅助／控制（Ａ／Ｃ）模式。ＰＳＶ或Ａ／Ｃ模式应从低压力或低容量起始逐渐过渡到高压力或高容量。面罩通气的比例、有效率、住院患者的总有效率由早期的４８％，４６％，７２％升至中期的７９％，６７％，７２％和近期的８５％，８３％，８１％。鼻梁部糜烂和胃胀气的比例逐渐下降，３期分别为２７％，４６％；１２％，３８％；７％，２１％。结论呼吸机性能、面罩特性、通气模式的选择和通气参数的调节会影响面罩通气的成败。
URPOSE To investigate the influence of technologic factors to face mask mechanical ventilation in chronic obstructive pulmonary disease (COPD) with respiratory failure.METHODS Three periods were divided according to the efficacy of the ventilator the face mask, ventilating modes, and the regulation of the ventilating parameters. The face mask ventilating effect and side effects in three periods were compared, and clarified from respiratory physiology.RESULTS The materials and fixing methods of the mask, the fulling of the air pad could affect the comfortable degree of patients and airtighting degree of the mask. Pressure support ventilation (PSV) had better synchronism, lower mask pressure on face, and higher ventilating efficacy than Assist/Control (A/C) mode. But A/C mode are necessary when patients had lower respiratory centre excitability or severe respiratory muscle fatigue. The pressure or total volume should be elevated from lower level when PSV or A/C mode was used. The effective rate of face mask ventilation, the total effective rate of hospitalized patients increased gradually from 46%, 72% of the initial period to 67%, 72% of the middle period, and 83%, 81% of the near period, but the ratio of cases who had necrosis and gastric insuflation decreased gradually from 27%, 46% to 12%, 38%; 7%, 21% at the same period.CONCLUSIONS The function of ventilators, mask characaristics, selection of ventilating modes and adjusting of ventilating parameters determined whether face mask ventilation was successful or not.
出处
《上海医科大学学报》
CSCD
1998年第2期127-130,共4页
Journal of Fudan University(Medical Science)
基金
国家"八五"攻关课题"发展无创性机械通气预防和治疗肺心病呼吸衰竭技术"资助
关键词
阻塞性肺疾病
呼吸衰竭
面罩通气
机械通气
chronic obstructive pulmonary disease
respiratory failure
face mask mechanical ventilation
technologic factors
