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17. 急性呼吸衰竭
概 述
呼吸衰竭(respiratory failure)是指各种原因引起的肺通气和(或)肺换气功能严重障碍,以致在静息状态下亦不能维持足够的气体交换,导致低氧血症伴(或不伴)高碳酸血症,进而引起一系列病理生理改变和相应临床表现的综合征。其临床表现缺乏特异性,明确诊断有赖于动脉血气分析:在海平面、静息状态、呼吸空气的条件下,动脉血氧分压(PaO 2)<60mmHg,伴或不伴二氧化碳分压(PaCO 2)>50mmHg,并排除心内解剖分流和原发于心排血量降低等因素,可诊断为呼吸衰竭。以下是急性呼吸衰竭诊治的临床路径。
表17.1 急性呼吸衰竭的临床特征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.1_14133.jpg?sign=1739155735-Dn83ypt2nskaQeloLWmuueEI2cxiNZw3-0-ac25557c1fa503d18db8bf71b00221d5)
注:院内的呼吸衰竭进展通常原因为肺炎、吸入分泌物或胃内容物、肺水肿或使用镇定药
表17.2 急性呼吸衰竭需进行的紧急检查
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.2_59668.jpg?sign=1739155735-Dk7CvXYHgdHzgZwENqUDgAWHcW7Z3iYm-0-578366dfe501a14cfd2ce0903c5ddbcf)
表17.3 急性呼吸衰竭的常见病因
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_14157.jpg?sign=1739155735-3qYQ44zlqCdKdm3EnHA18GAkv54ENDUy-0-75ba797cd6c3354be58fc171f145fd4c)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1739155735-nq2TcCJUsHJxQhdJJWVUmneVO4pWc7TW-0-0c032054f64288f2a93ffeabb517d48f)
表17.4 急性呼吸衰竭的处理:一般原则
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.4_14209.jpg?sign=1739155735-mcR3OSiIwyu9gAFft64iuw1uR6p5HMCB-0-6f9c64faf1ad073acc00c03cb7b8b6d3)
表17.5 呼吸衰竭的处理:无创通气支持
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_59989.jpg?sign=1739155735-SmmmCEGJ2jDaLVriYxlV5tXy71qrfMz4-0-5e074f167d4ad950786174b9c877c15e)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1739155735-IAR5dOLDlv6q6kxY5S6YzA9XJLNMOBWj-0-5c1344a8c1836469901891734ea9cc2c)
注:AECOPD,慢性阻塞性肺疾病急性发作; *,相对禁忌证
表17.6 呼吸衰竭的处理:有创通气治疗
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.6_59992.jpg?sign=1739155735-9YqR3mRkzcZPxSPXCeGsf0QI2YkXatFY-0-a8f2a6d7629495da9bfd064a9cd013ea)
注:COPD,慢性阻塞性肺疾病;GCS格拉斯哥昏迷评分;NIV,无创通气
表17.7 机械通气及气管内插管的指征
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_14406.jpg?sign=1739155735-PxEUXYhnaSoUyjS8lPjhRiOMq7IStaUC-0-08193296a77a6b4cdf2b45d98ea8fa2f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1739155735-HfuAAhpPBhPsab8JBFJyvxw7SXcyy2va-0-fc82d9db079d0a49d725c8aa20591ccc)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1739155735-Y4MYaftlpEJELCSdeNIWpfi3KjsCLrm9-0-78b5e780f04a59a3e39635409c63f3b3)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1739155735-kgWKG5fJ2cR4pKVC470kQLeDb5HCAALX-0-451cfd14a152cbc06324ecadbca8fa60)