Supplemental oxygen and noninvasive ventilation.
Supplemental oxygen and noninvasive ventilation.
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DOI：
10.1183/16000617.0159-2022
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发表时间：
2023-03-31
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--
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呼吸系统试图维持氧气和二氧化碳的正常水平。然而，晚期COPD患者的气流受限、实质异常和呼吸泵功能障碍可能会受到影响，最终导致呼吸衰竭，伴动脉氧分压降低（低氧血症）和/或动脉二氧化碳分压升高（PaCO 2;高碳酸血症）。重度COPD患者即使戒烟并优化药物治疗，低氧血症仍可能持续存在。长期氧疗（LTOT）可以改善白天严重低氧血症患者的生存率，而低氧血症不太严重的患者可能仅改善运动能力和呼吸困难。睡眠期间发生的呼吸生理变化进一步易患低氧血症，特别是在COPD患者中。然而，低氧血症的主要原因是换气不足。无创通气（NIV）可降低COPD和急性高碳酸血症性呼吸衰竭患者的死亡率和插管需求。然而，NIV也可以改善稳定的慢性高碳酸血症患者的生存率和生活质量，现在建议在临床稳定和优化药物治疗（包括LTOT，如有指征）后，对长期高碳酸血症患者（例如出院后2-6周PaCO 2>55 mmHg）进行NIV。 关于NIV治疗的最佳模式、设置和目标仍存在许多问题。在COPD患者中，长期氧疗可改善严重日间低氧血症患者的生存率，无创通气可减少急性高碳酸血症呼吸衰竭后插管的需要，并改善慢性高碳酸血症稳定患者的生存率。https://bit.ly/3yaLYTb
The respiratory system attempts to maintain normal levels of oxygen and carbon dioxide. However, airflow limitation, parenchymal abnormalities and dysfunction of the respiratory pump may be compromised in individuals with advanced COPD, eventually leading to respiratory failure, with reduced arterial oxygen tension (hypoxaemia) and/or increased arterial carbon dioxide tension (PaCO2; hypercapnia). Hypoxaemia may persist in individuals with severe COPD despite smoking cessation and optimisation of pharmacotherapy. Long-term oxygen therapy (LTOT) can improve survival in those with severe daytime hypoxaemia, whereas those with less severe hypoxaemia may only have improved exercise capacity and dyspnoea. Changes in respiratory physiology that occur during sleep further predispose to hypoxaemia, particularly in individuals with COPD. However, the major cause of hypoxaemia is hypoventilation. Noninvasive ventilation (NIV) may reduce mortality and need for intubation in individuals with COPD and acute hypercapnic respiratory failure. However, NIV may also improve survival and quality of life in individuals with stable, chronic hypercapnia and is now suggested for those with prolonged hypercapnia (e.g. PaCO2 >55 mmHg 2–6 weeks after hospital discharge) when clinically stable and after optimisation of medical therapy including LTOT if indicated. Many questions remain about the optimal mode, settings and goal of NIV therapy. In COPD, long-term oxygen therapy improves survival in severe daytime hypoxaemia and noninvasive ventilation reduces the need for intubation after acute hypercapnic respiratory failure and improves survival in stable in chronic hypercapnia. https://bit.ly/3yaLYTb
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影响因子：
24.3
作者：
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