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頁籤選單縮合
題 名 | 非侵襲性呼吸器=Noninvasive Ventilators |
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作 者 | 連德正; | 書刊名 | 中華民國重症醫學雜誌 |
卷 期 | 2:1 2000.01[民89.01] |
頁 次 | 頁44-54 |
專 輯 | 胸腔重症專題 |
分類號 | 415.415 |
關鍵詞 | 機械式呼吸輔助; 非侵襲性正壓呼吸器; 非侵襲性呼吸器; Mechanical ventilation; Noninvasive positive pressure ventilators; NIPPV; Noninvasive ventilators; |
語 文 | 中文(Chinese) |
中文摘要 | 非侵襲性呼吸器(Noninvasive ventilators)之最大優點在於能避免人工氣道的併發症,同時達成輔助呼吸的目標。其大致可分為三類:一、移動腹部之呼吸輔助裝置:如搖床(Rocking bed)、氣帶(Pneumobelt)等;二、負壓呼吸器:如鐵肺、雨衣式(Raincoat)或夾克式(Jacket)、胸甲(Chest cuirass)等;三、非侵襲性正壓呼吸器(NIPPV)。使用效率上以NIPPV、鐵肺為最佳:氣帶、夾克式負壓呼吸器次之;胸甲、搖床最差。負壓呼吸器由於使用中特別是睡眠時,常發生上呼吸道塌陷阻塞,造成呼吸受阻乃至缺氧,而且太過笨重,攜帶困難,目前已退居第二線。 此類呼吸器使用於神經肌肉疾病、胸廓畸形及中樞性通氣不足,所導致的慢性呼吸衰竭,效果受到一致的肯定,是使用之最佳對象,至於對於重度慢性阻塞性肺疾之效果至今未有定論。近幾年來,使用NIPPV於急性通氣衰竭的結果更是令人振奮,尤其在COPD併發急性惡化時,其效果已獲得充分證實,其他雖有待研究但初步結果相當看好的使用時機包括:氣喘、拔管後、手術後、外傷後、心因性肺水腫、或等待肺臟移植的病人等,都是可能的受惠者。此外,由於此類病患較為危急,使用前大家要熟悉各種呼吸器的操作及鼻面罩之固定技巧,並先排除不適合使用的病人,使用中更要密切監測、迅速反應,才能避免危險、獲得療效。 |
英文摘要 | Noninvasive ventilators can provide ventilatory support without an artificial airway. They have better acceptance, fewer complications and are usually more comfortable than conventional ventilators. They include: 1. Ventilators that displace abdominal contents, such as rocking bed and Pneumobelt; 2. Negative pressure ventilators such as iron lung, raincoat or jacket, and chest cuirass; 3. Noninvasive positive pressure ventilators (NIPPV). Iron lung and NIPPV are the most efficient of all. Negative pressure ventilators, which are heavy and cumbersome, may result in upper airway collapse and nocturnal oxygen desaturation. Therefore, they are considered as second-line choice. In studies on patients with chronic ventilatory failure due to neuromuscular diseases, chest wall deformities, or central hypoventilatory syndrome, intermittent use of noninvasive ventilators showed unanimously beneficial. Their effects on patients with stable chronic obstructive pulmonary diseases remain controversial. The use of NIPPV in some selected patients with acute respiratory failure became more and more popular over the past decade. Its efficacy seems encouraging with an average success rate of 70%. Facing acute exacerbation of chronic obstructive pulmonary diseases (COPD), several well-controlled studies have confirmed that NIPPV can significantly reduce mortality, ICU stay and the duration of mechanical ventilation. Therefore, in most of cases, it can substitute endotracheal intubation to act as a first-line treatment. As for the patients with acute respiratory insufficiency after extubation, postoperation and status asthmaticus, the results from limited studies are also promising. However, the efficacy of NIPPV on acute hypoxemic respiratory failure such as acute respiratory distress syndrome (ARDS), remains controversial. NIPPV should, therefore, not be sued until further investigations are completed. To get the best of NIPPV shall require the medical staffs to get familiar with the modes and the settings of ventilators, as well as the problems of the interfaces. During the use of NIPPV, both meticulous monitoring and the ability to timely intubation are mandatory since its complications may sometimes be fatal. |
本系統中英文摘要資訊取自各篇刊載內容。