Respiratorysystemwithinternalprotection

1、最新資料推薦Respiratory system with internal protecti onRespiratory system with internalprotection 呼 吸衰竭respiratory failure 簡(jiǎn)稱 呼衰，是指由各種原因引起的肺通氣和 （或）換氣功能嚴(yán)重障礙，以致靜息狀態(tài)下不能維持足夠的氣體交換 導(dǎo)致低氧血癥伴（或不伴）高碳酸血癥，進(jìn)而引起一系列病理生理 改變和相應(yīng)臨床表現(xiàn)的綜合征.明確呼衰診斷需依據(jù)動(dòng)脈血?dú)夥治?-若在海平面、靜息狀態(tài)、呼吸空氣條件下，動(dòng)脈血氧分壓（pao2） 60mmhg,伴或不伴二氧化碳分壓 （paco2） 50mmhg, 并除外

2、心解剖 分流和原發(fā)于心排血量降低等因素所導(dǎo)致的低氧，即可診斷為呼吸衰竭.* 按動(dòng)脈血?dú)夥治龇诸悾?、1型呼衰-僅有缺氧，無co2 潴留，血?dú)夥治鎏攸c(diǎn)為：pao2 60mmhg, paco2降低或正常，見于換 氣功能障礙.2、二型呼衰：既有缺氧，又有co2潴留，血?dú)夥治?特點(diǎn)為：60mmhg pao2 50mmhg, paco2,系肺泡通氣不足所致. 臨 床表現(xiàn)：主要為缺氧和co2潴留所致的呼吸困難和多臟器功能損害 1、呼吸困難2、發(fā)紺是缺氧的典型表現(xiàn)3、精神-神經(jīng)癥狀先興 奮后抑制，煩躁不安、晝夜顛倒、譫妄、肺性腦病等4、循環(huán)系統(tǒng) 表 現(xiàn)球結(jié)膜水腫、溫發(fā)紺5、消化和泌尿系統(tǒng) 損害肝、腎功能治療

3、要點(diǎn)：在保持呼吸道通暢的條件下，迅速糾正缺氧、co2潴留、酸堿 失衡和代謝紊舌L .The function of prevention and treatment of multiple orga n damage, active treatme nt of primary disease,eliminate the cause, prevention and treatment of complicationsin 1, to maintain airway pate ncy (elim in ati on of respiratory secretio ns and foreig nbo

4、dy, relievebron chialspasm,establishme ntof artificial airway) 2,oxyge n therapyprin ciple is the type two respiratory failure patie nts should be given low concentration( 35%) continuous oxygen inhalationA type of respiratoryfailure may be givena higherconcentrationof oxygen (35%) FiO2 (%) =21 4* o

5、xygen flow rate(L/mi n) 3, i ncrease the volume of ven tilati on, reduce CO2 rete ntio n (respiratory stimula nt, mecha ni cal ven tilatio n) 4, anti in fecti on 5, correct acid-base disturba nee, the most com mon complicati on of respiratory failure and respiratory acidosis Acute respiratory distre

6、sssyn drome acuterespiratory distress syn drome ARDS is a severe stage of acute lung injury acute lung injury ALI, which is the two stage of the same disease process. ALI and, or ARDS are acute and progressive dysp nea caused by various internal and exter nal factors other than cardiogenic.The clini

7、calfeatures includeshort ness of breath, respiratory distress, and in tractable hypoxemia. Main pathological features:high proteinexudative edema and tran spare nt membra ne formati on caused by high permeability of microvessels The detection of protein in lung fluid can distinguish cardiogenic (exu

8、date) and non最新資料推薦cardioge nic (leakage) respiratory distress, and the respiratory distress caused by ARDSis high. Etiological factors: severe infection, trauma, sucking of gastric contents, preg nancy in duced hyperte nsion syn drome, etc. The cli ni cal mani festati ons - ofte n in five days afte

9、r on set of primary disease, sudde n progressive respiratory distress (28 /min), cyano sis, short ness of breath, usually cannot be improved by oxygen therapy,Nor can it be explained by other cardiopulmonary reas ons 1, X chest - fast and cha ngeable 2. Arterial blood gas an alysis - a typical mani

10、festati on of low PaO2, low PaCO2 and high pH value. PaO2/FiO2 is the most com monly used in dex, a n ecessary con diti on for the diag no sis of ALI or ARDS. The normal value is 400500mmHgALI =300mmHg, ARDS =200mmHg. 3. The ratio of in effectivecavityven tilati on(Vd/Vt) isin creased as a differe n

11、tial diag no sis Diag no stic poin ts: 1.High risk factors for ALI and, or ARDS 2. Acute on set, frequency of breathing, or respiratory distress 3. The oxygen and in dex =300mmHg of hypoxemia are ALI, =200mmHg is ARDS 4,pulmonary capillarypressure PCWP=18mmHgc, clinicallyexceptcardioge nicedema 5, t

12、wo lungin filtrati ngshadowsTreatme nt poin ts:1, oxyge n therapy gen erallyn eeds highconcen trati on (50%) supply with mask to make PaO2=60mmHg or SaO2=90% 2. Mechanical ventilationshould be applied to mostpatientsas early as possible. Positive end expiratorypressure PEEP; tidal volume; ventilatio

13、nmodeselection (withno rmal call, sucti on ratio on the con trary, can improve the oxyge nati on) 3. The early use of colloid soluti on for liquid man ageme nt Glucocorticoid therapy ARDS patie nts ofte n die from primary disease, multiple orga n failure, multiple orga n failure MOFand in tractableh

14、ypoxemia * give oxyge n: 1, a typeARDS respiratory failure and the patie nts n eed in halati on of high co nee ntratio nsof oxyge n (FiO235%),Make PaO2 fast to6080mmHgr SaO290% 2, type two respiratory failure patients are usually PaO260mmHg before oxyge n therapy should be give n low concen trati on

15、 (35%) for oxyge n, make the PaO2 con trol in 60mmHg or SaO2 in 90% or slightly higher, to preve nt hypoxia completely correct, the peripheral chemoreceptor lose hypoxemia stimulati on caused respiratory depressi on .It will lead to respiratory frequency and amplitude decreased, in creased hypoxia a

16、nd CO2 rete nti on Commonly used oxyge n feeding methods: nasal catheter, nasalplug, mask oxygen Then asal catheter and n asal oxyge n for mild respiratory failure or type two respiratory failure patients Nonrebreathing mask最新資料推薦oxyge n (Ve nturi mask) commo nly used in severe hypoxemia and respira

17、tory state of unstable type and ARDSpatientswithrespiratory failure * watch the effect of oxyge n therapy * monitoring:respiratory failure and ARDS patients wereadmitted to the ICU for inten sive care 1,2,respiratorycon diti on of hypoxia and CO2 rete nti on - without cyano sis, conjunctival edema,a

18、bnormal breathing and pulmonary rales in3, 4, circulationconsciousness and neuropsychiatric symptoms-withoutpulmonary encephalopathy,assessment of pupil,muscular tension, tendon reflex and pathological reflex, 5 TiY epi ng equilibrium 6, laboratory exam in ati on results, blood gas an alysis and biochemical exam in atio n Primary bron chial lung cancer primary bronchogenic carcinoma lung cancer - tumor cells derived from the bronchial mucosa or gland, often have regional lymph node and blood metastasis early,oftenirritati ng cough and bloody sputum and respiratory symptoms, biological charact