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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=1734461221-KTW6iqTzMhTxBOTFdUkJPeD65G5IbkVV-0-41fe9bdb65b14a6ea4391120712576d2)
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=1734461221-34VZPrv4aPfceiy3Vf0r7VmaFstuT7A3-0-dd6770b3b8422881e51c0cc3cb0dd65e)
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=1734461221-067lEDZgGUKfUk64O6OyKp2q39Kruka2-0-7e828868b11d219f41deccaab2deeb61)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1734461221-a1dam9wnFKaEvZzOmM93JIXR4K9AlLqD-0-184360893e18e670074ec50bd5e270ca)
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=1734461221-Vgz7yy3cQCqm3R4I1wcQienaSRbPGqrc-0-70d44e5265ef27c28c30a2766be595af)
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=1734461221-p4tuzPjy4TeWZ4S0vyC3LyLq9MZX2toD-0-5a9ff678d1ba88c3c12e735336e21c2f)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1734461221-Sx9t7pKDcVB2v7PLtZ9KS7n0I92s0HPL-0-ddb87c9a072e273ea217dd2335302003)
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=1734461221-XY9BzsD2rCp2aNGEfvTeZFGnzCMJwECH-0-e2b178f4858bad2f2750c5d6889691cc)
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=1734461221-02Uq6JvFBQFqHNHU5cbA0VvkVhqvvR8z-0-7df4d8ed3c0df4bdb1d1e5559cefdc32)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1734461221-fBWvlccILpyxqVvpuYQi0c7GDIbjKgrE-0-841dc827b7972f5b051d9dc481670245)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1734461221-fE4qa8lyv68UiG9PH3y4iGxCAfisOhck-0-c4e60a3b8b7b33b425622e3d47b60932)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1734461221-TXiVX8qNx9nzTJq7elVyWjF728XaxICs-0-f1ae478c289baa69d09ea5de4c02a074)