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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=1738900757-QMja8JYgenHbgdNNRjd9PAwnhFm1JQch-0-fdf6f42c2942c3497760d9bb5e70b213)
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=1738900757-jf7l2OfNu4pkYLlAapglCblfmSg0KjlN-0-8c619c0dec01963faeef5a79adc51dca)
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=1738900757-qbyxn8qAZa7Vp3IBiFsu6P5cEW1z8R9c-0-d9a0555ee2c43ff0c7a3e9cc51bdf4db)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1738900757-NTcHle5cTwwCIKhmPJmKuVv7OVlBRLnV-0-731beedeb7d90a96a734b458138a62ac)
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=1738900757-Oge2E03B2z98H3bVfZRsu0F2u3GBgPRA-0-b5818416f18b619eb097c9681c16719e)
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=1738900757-JljvmIA5cxAt2uiviAdBfJlAu9Xe7tj6-0-6dd91f7b810b99636db9bf2af0f9b710)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1738900757-w8ttWtcEKWNjTZuSiGwVBM3SV6e3pm2W-0-e7287bfeb8c5ef843ef747772ab4d1c4)
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=1738900757-q6nELlWR14kBglqKU1Dz4Kfv9sdEsbKT-0-701f51dacaeed78beb7d4071dd451d4e)
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=1738900757-fNcbd45sKCtIhdcIl4rUWpKINB6lmwup-0-6468b9779ceca29c7ab56e3e6cc5dd71)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1738900757-DsbQKrWbNhIw1hEizziQl7pAiXIFGPIQ-0-62cff795a7c26c76799885ab4fe64cdb)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1738900757-ME47M01fThHOZFBLsy1yfUr6KK3OG37m-0-6345f8d27ec01db28c9543df0f6237d7)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1738900757-swqCYG0LrHBuOEHAWYRBO95IguzM9Z5f-0-d9ad9a2752e3fb2ecea2d48a6d55eb02)