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題名 | 急性呼吸衰竭=Acute Respiratory Failure |
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作者 | 林清基; Lin, Ching-chi; |
期刊 | 中華民國重症醫學雜誌 |
出版日期 | 20020100 |
卷期 | 4:1 2002.01[民91.01] |
頁次 | 頁69-80 |
分類號 | 415.3 |
語文 | chi |
關鍵詞 | 急性缺氧性呼吸衰竭; 原發性換氣衰竭; 醫原性併發症; Acute hypoxemic respiratory failure; Ventilatory failure; Iatrogenic complication; |
中文摘要 | 當患者無法足夠換氣或無法供給血液或全身器官足夠的氧氣時即可診斷為呼吸衰竭。由呼吸衰竭引起的機轉可將急性呼吸衰竭區分成二型。第一型急性缺氧性呼吸衰竭,主要的特點為肺内分流引起動脈血氧低下,即使過度換氣使血液中二氧化碳分壓下降,並給予氧氣治療也常無法校正動脈血氧低下。第二型因換氣衰竭引起的急性呼吸衰竭,是由於肺泡換氣不足,引起動脈血二氧化碳堆積,動脈血二氧化碳昇高合併動脈血氧分壓下降,此類型的動脈血氧分壓下降可容易經氧氣治療來予以校正。 急性缺氧性呼吸衰竭是由於肺泡萎縮,或充滿氣體以外物質(如液體或細胞等),當混合靜脈血通過有病灶的肺泡而未行氣體交換,即會引起動脈血氧低下。此外由於肺泡及間質組織充滿液體,因此肺可張性減少,患者所需呼吸工也因此增加。急性缺氧性呼吸衰竭一般可分廣泛病灶(例如肺水腫)及局部病灶(例如大葉性肺炎)兩種。 原發性換氣衰竭會導致動脈血二氧化碳分壓昇高及動脈血氧氣分壓下降,此即第二型呼吸衰竭,致病機轉包括抑制中樞神經系統呼吸驅駛力,神經肌肉機能不足,呼吸系統負荷太大,未能有效排除二氧化碳並引起動脈血pH值下降,動脈血氧分壓下降。雖然動脈血二氧化碳分壓昇高是不被期望的,但治療不當,在使用呼吸器時可發生危及生命的併發症,即壓力傷害。但目前的容忍性高二氧化碳血換氣法即在減少肺泡壓而非減少動脈血二氧化碳分壓昇高,以減少使用呼吸器引起的併發症。 總結:急性肺衰竭為内科主要急症。它的診斷依賴醫護人負的高度警覺性。治療的主要原則為(1)利用各項生理學指標,呼吸生理學為處理之準則。(2)治療矯正可逆轉因素,使病況回復至衰竭前的慢性穩定狀態。(3)要避免醫原性併發症之產生。 |
英文摘要 | Respiratory failure (RF) is diagnosed when the patients loses the ability to ventilate adequately or to provide sufficient oxygen to the blood and systemic organs. There are two major types of respiratory failure. Intrapulmonary shunt causes hypoxemia refractory to oxygen therapy despite hyperventilation and reduces PaCO₂ in type I or acute hypoxemic respiratory failure (AHRF). Primary failure of alveolar ventilation leads to CO₂ retention and arterial hypercapnia associated with reduced PaO₂ that can be corrected easily with O₂ therapy in type II or ventilatory failure. The alveoli are flooded by fluid or cellular exudate with collapse in AHRF. Therefore, venous admixture increased. Besides, when the interstitial tissues and alveoli are filled with the exudate, the lung compliance decreased and the work of breathing increased. AHF can be classified as diffuse type (e.g. acute pulmonary edema) and focal type (e.g. lobar pneumonia). Type II or ventilatory failure is characterized by high PaCO₂ and low PaO₂. The causes of ventilatory failure include depressed central ventilatory drive, neuromuscular dysfunction, and increased ventilatory load. Ineffective excretion of the CO₂ may result in low pH and low PaO₂. While a high PaCO₂ is not desirable, inappropriate mechanical ventilation to lower the PaCO₂ (such as increased tidal volume) may lead to barotrauma that can be life-threatening. Permissive hypercapnia may decrease the risk of barotraumas with an acceptable increased PaCO₂. In conclusion: acute respiratory failure is a medical emergency. The diagnosis is depend on the alert of doctor, nurses, and respiratory therapist. The main therapeutic principle is firstly physiological approach, secondly is correct the reversible factors and thirdly is to avoid iatrogenic complication. |
本系統之摘要資訊系依該期刊論文摘要之資訊為主。