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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=1739288607-lNCXVy3msIqYpAelh6ck6cvfPl5HMSP1-0-47d19d27dd6c1dbf0ba160425e9461c5)
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=1739288607-afuRYmL6PAbDHBmWhW9XeUnFlzU7Uct3-0-1f20803193ed3ad7dad6a0135379d812)
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=1739288607-e1O24U05HU3N3uecPre3H6um1YPU4nKX-0-5c642e846a6d6d7abd9582e834222fdb)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1739288607-8vHHxd5mYzivMuBgW7vxWGheDrmYrLST-0-832a9ad41d8d132f278552b016fb13c5)
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=1739288607-fMgUdbgplGuMhhc7st9HI31xZavXrG0F-0-855be58659ab2612bfd0d82f17c0dce5)
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=1739288607-k2XOYlGXI7RL7MB2Uk4ZrxSjyzEC42By-0-d845d71355d02a3d907a739db6882e1b)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1739288607-ar3bKqJWW5D1Ih679Wdu0NpBGP8vQMlO-0-276492f39c6fb8e432ccff8cf6aa686a)
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=1739288607-tFfDlMR3Oe8MDxYRgLs22AsGWZS2G1Xp-0-ee77985692555ea7ef2421c741c1dfa8)
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=1739288607-rMCYRc46EirwpK8RurAZnvhafJIlrpp2-0-d8b3eda3b863d2b6bd6acec471083462)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1739288607-ay8naXGkFIK82MHRCpb1owvcohveo0in-0-6eaf602c13a7952af51cd87d367110b7)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1739288607-uA1b2hQ2tmIVrjMqoMaTgpJpeeRkid0A-0-1dfcfe6c406aad7c6039dee8d3025d6b)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1739288607-r90WtH9J3gnZ5IeNg2EhMl1aPVeBWDz1-0-b2afb9d19cacee8c5098b3c14c72019f)