抽象的
如果保守治疗失败,已在治疗急性呼吸衰竭(ARF)时表明机械通气(MV)。侵袭性MV与各种并发症有关。最近的MV(NMV)的非侵入性方法的创新避免了侵入式MV的并发症,同时确保了类似程度的疗效。从1989年到1995年的文献述评显示,在涉及超过400名患者的涉及超过400名COPD的患者的研究中,据报道了NMV在ARF中的使用。NMV成功51%至91%,ARF的严重程度在不同的研究中广泛不同。大多数研究与历史群体的历史群体比较了患有“常规”医疗治疗的历史群体的效果,同时缺乏对NMV的受控研究。面膜类型,通风方式,遵守治疗,患者类型和疾病的严重程度可能会影响成功率。NMV的成功与不太严重的基线临床和功能参数相关,并且在NMV的初始试验期间评估的酸中毒水平较小。因此,NMV可用于ARF的选定患者。患者应该具有ARF的临床和生理证据,应该足够合作。 It is commonly said that NMV should be avoided, and endotracheal (ET) intubation performed in patients with haemodynamic instability, uncontrolled arrhythmias, gastrointestinal bleeding, high risk for aspiration. With these limitations NMV in selected patients with ARF is well tolerated and may be useful in avoiding ET intubation in most cases of COPD and with a wide range of success rates in other disease. This in turn has several advantages in terms of avoiding complications of invasive MV, reducing the length of stay in ICU and probably the number of ICU readmissions. Side effects of NMV seem less severe than those induced by invasive MV. In conclusion in selected patients a trial of noninvasive mechanical ventilation, as an adjunct to medical therapy, should be instituted at an early stage of ARF episodes before severe acidosis ensures, to avoid ET intubation.