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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=1739217614-6jnQ5pXKLN3Iee8HdkGhq6QDklsGQUFA-0-0ec24d6f655417163496b43271c7fb4b)
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=1739217614-j1R07QEzVdH4Uv7R3Ri43im6qIg4R5ai-0-3d91bfbc6096d85bc3a8ccd83ad371f4)
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=1739217614-vheLkoi8EFSBKfrp61yJsC33LUtEJr5k-0-476f1d9c5c1f6721e1731ae843f78a72)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1739217614-1UmuvBuSbGC5q5vxkYLQVqHrlszZsCus-0-775fe69aace05dcc4a6792208c011fb9)
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=1739217614-i74a8XNTIChEHwPuVqYN0NJA9NJI5te6-0-1dc619d3249b0bc26baa4e344d1a50f5)
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=1739217614-JcTaWYSNDRoCfEk8vGRmLeQvRLgPWfMy-0-ca79f3fee84e22c7dc292bca62f6efdc)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1739217614-X5zHFN9nHno552cpbdDBPZeGVtV0dux9-0-5df7fe027f54655d56766b8741cb524f)
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=1739217614-5eZSRSMKaE7DwVm6X5XUDsMs0KedeXmu-0-7e9afada4c13e93bf7166d96ccf3b701)
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=1739217614-hmfL5b4inrKVATMvmw4ZmX4bCCcOZHf8-0-971efd819f569778250892e9a0f0e4b9)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1739217614-lrTTeEJsQMCrTxUofRXbQdAIIJ40UmFO-0-015ca77dc0c635ba43e8ae07035aacc0)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1739217614-AdgEyOewHAVCsaJ93SVYjrmZrIjuUkjt-0-968d420afba47774a820b50df5dcad55)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1739217614-mYOArNDOGIhFMQcCC23nsDMrey7QSbjx-0-945515d779c0ac7994ff149d359f4cd9)