TY - JOUR T1 -无创机械通气治疗急性呼吸衰竭JF -欧洲呼吸杂志JO - Eur Respir J SP - 795 LP - 807 DO - 10.1184 /09031936.96.09040795 VL - 9 IS - 4 AU - Ambrosino, N Y1 - 1996/04/01 UR - //www.qdcxjkg.com/content/9/4/795.abstract N2 -机械通气(MV)在保守治疗失败的急性呼吸衰竭(ARF)治疗中已被证实。有创性MV与多种并发症相关。近年来创新的无创性MV方法避免了有创性MV的并发症，同时保证了相似程度的疗效。回顾1989年至1995年的文献表明，在涉及400多名患者的多项研究中，NMV在急性肾功能衰竭中的使用已被报道，其中大多数为COPD。NMV的成功率从51%到91%，不同研究中ARF的严重程度差异很大。大多数研究比较了NMV与历史上接受“常规”药物治疗的患者的疗效，而缺乏NMV与ET插管的对照研究。口罩类型、通气方式、治疗依从性、患者类型和疾病严重程度都可能影响成功率。NMV的成功与较轻的基线临床和功能参数异常以及较轻的酸中毒水平相关，在NMV的初始试验中进行了评估。因此，NMV可能对特定的ARF患者有用。患者应具有ARF的临床和生理证据，并应充分配合。 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. ER -