白春学－呼吸衰竭

RespiratoryFailureBaiChunxueDepartmentofRespiratorydiseaseZhongshanHospitalFudanUniversityChapter7复旦呼研所1KeyWordsRespiratoryfailureAcuterespiratorydistresssyndrome(ARDS)dyspnea

Hypoxemiahypercapnia

RespiratorySupportMechanicalventilationPositiveend-expiratorypressure(PEEP)复旦呼研所2

RespiratoryFailureDefinitionChapter7TypeI、IIRespiratoryFailureCentrol、Non-Centrol

RespiratoryFailureAcute&ChronicRespiratoryFailure复旦呼研所3

ACUTERESPIRATORYFAILUREBaiChun-XueDepartmentofRespiratorydiseasesZhongshanHospital复旦呼研所4respiratorydysfunctionresultinginabnormalitiesofoxygenationorventilationimpairorthreatenthefunctionofvitalorgansDefinition复旦呼研所5TypeIParenchymaEdemaVasculardiseaseChestWall&PleuraldiseaseTypeIIAirwayobstructionNeuromusculardiseasePathogeny复旦呼研所6hypoxemiaPerfusionDiffusionVentilationCO2CO2O2O2ClinicalFindings复旦呼研所7PAO2，PACO2（kPa)hypercapniaCO2O2ClinicalFindings复旦呼研所8

cyanosis,restlessnessconfusion,anxiety,delirium

tachypnea,tachycardiahypertension,cardiacarrhythmiastremorHypoxemia复旦呼研所9Dyspneaandheadache

peripheralandconjunctivahyperemiahypertension,tachycardia,tachypneaimpairedconsciousnesspapilledema,andasterixis

Hypercapnia复旦呼研所10DiagnosisPaO2<8kPaPaCO2>6.66kPa复旦呼研所11specifictherapydirectedtowardtheunderlyingdisease;respiratorysupportivecaredirectedtowardthemaintenanceofadequategasexchange;generalsupportivecare.Treatment复旦呼研所12Nonventilatoryaspects

Ventilatoryaspects

A.RespiratorySupport复旦呼研所13SaO2of≥90%(PaO2about60mmHg).Hypoxemiainpatientswithobstructiveairwaydiseaseisusualeasilycorrectedbyusinglow-flowoxygenbynasalcannula(1–3L/min)orVenturimask(24–28%).HigherconcentrationsofoxygenarenecessarytocorrecthypoxemiainpatientswithARDS,pneumonia,andotherparenchymallungdiseases.Nonventilation复旦呼研所14经鼻面罩机械通气治疗前后血气变化（X±S）白春学,等.应用国产呼吸器经鼻面罩治疗慢性阻塞性肺病所致呼吸衰竭9例报告.上海医学1993;16:102复旦呼研所15Trachealintubation

Mechanicalventilation

Ventilation复旦呼研所16HypoxemiawhichisnotquicklyreversedbysupplementaloxygenAirwayobstructionImpairedairwayprotectionInadequatehandl