160例呼吸衰竭患者的诊治研究  

Diagnosis and Treatment of Respiratory Failure:A Report of 160 Cases

作　　者：顾艺难[1] 秦少云 

机构地区：[1]泰州市人民医院呼吸科,江苏泰州225300

出　　处：《实用临床医学（江西）》2013年第8期18-20,共3页Practical Clinical Medicine

摘　　要：目的探讨呼吸衰竭的临床特点,总结诊断和治疗的要点。方法对160例呼吸衰竭患者诊治过程进行回顾性分析。结果 160例患者中,急性呼吸衰竭74例,其中严重肺部感染所致10例,胸部外伤严重累及呼吸肌或肺组织14例,尿毒症或肺癌胸膜腔积液短期内大量增多18例,自发性气胸8例,心源性肺水肿6例,重度中枢神经系统感染累及呼吸中枢6例,其他病因12例;慢性呼吸衰竭86例,其中慢性阻塞性肺病(COPD)64例,间质性肺疾病8例,硅肺、石棉肺6例,其他疾病8例。动脉气血分析:PaO2<8.00 kPa、PaCO2正常为Ⅰ型呼吸衰竭者70例;PaO2<8.00 kPa、PaCO2>6.67 kPa为Ⅱ型呼吸衰竭者90例。160例患者经积极救治后6例死亡(4例严重胸部外伤、肺挫裂伤,2例尿毒症、全身多器官功能衰竭),病死率为3.75%。其余154例均存活。结论呼吸衰竭的诊断依赖于疾病的临床表现、动脉气血分析、呼吸功能检查及胸部影像学检查等。呼吸衰竭的治疗应依呼吸衰竭的类型和病因个性化治疗。Objective To explore the clinical characteristics of respiratory failure, and to summarize the key points of the diagnosis and treatment. Methods Data of 160 patients with respiratory failure were retrospectively analyzed. Results Among the 160 patients, 74 had acute respiratory failure and 86 had chronic respiratory failure. Among the 74 patients with acute respiratory failure, the disease was caused by severe pulmonary infection in 10, by severe chest trauma involving respiratory muscle or lung tissue in 14, by uremia or a large increase in lung pleural effusion in short term in 18, by spontaneous pneumothorax in 8, by cardiogenic pulmonary edema in 6, by severe central nervous system infection involving respiratory center in 6, and by other reasons in 12. Among the 86 patients with chronic respiratory failure, chronic obstructive pulmonary disease occurred in 64, interstitial lung disease in 8, silicosis or asbestosis in 6, and other diseases in 8. Arterial blood analysis showed that type I respiratory failure （Pa02〈8.00 kPa and normal PaCO2） occurred in 70 patients and type II respiratory failure （Pa02〈8.00 kPa and PAC02〉6.67 kPa） in 90 patients. Six of the 160 patients （3.75%） died after active treatment, including 4 cases of severe chest trauma and lung contusion and 2 cases of uremia and multiple organ failure. Conclusion The diagnosis of respiratory failure depends on the clinical manifestations, arterial blood analysis, respiratory function tests and chest imaging. Individual treatment should be performed according to the types and causes of respiratory failure.

关 键 词：呼吸衰竭 诊断 治疗 

分 类 号：R563.8[医药卫生—呼吸系统]