經鼻正壓呼吸器於支氣管擴張症併發呼吸衰竭患者之使用：病例報告

支氣管擴張症患者併發急性呼吸衰竭之情況並不少見．在急性期若併有呼吸衰竭常須藉助氣管插管及間歇性正壓呼吸器來維持患者之呼吸功能。而後大部分患者皆可戒除呼吸器而自行呼吸．但也有少數患者須長期依賴呼吸器以維持生命。在過去，氣管切開之間歇性正壓呼吸器(TIPPV)是這群須長期依賴呼吸器患者之唯一選擇，他們因有氣管造口，而須終生忍受其合併症。本文報告一名支氣管擴張症合併疑似中樞性肺泡換氣不足之患者，最近三年來因反覆肺部感染致呼吸衰竭，須依賴氣管插管及呼吸器以維持呼吸。我們利用非侵入性之經鼻正壓呼吸器維持這位患者之正常換氣功能，不僅使其避免氣管造口及因此而產生之合併症，而且馬上解除呼吸障礙之臨床症狀，進而使其能接受復健訓練，並改善其生活品質。

關鍵字

支氣管擴張症；經鼻正壓呼吸器；呼吸衰竭

並列摘要

It is not rare for the individuals with bronchiectasis, defining pathologically as a permanently abnormal dilation of subsegmental airways, to develop respiratory insufficiency as respiratory tract infection occurs. In acute stage, intermittent positive pressure ventilation (IPPV) via endotracheal tube is often mandatory to maintain their respiration, but most of them could breathe spontaneously later on. However, there are still a small number of patients remaining ventilator dependent cither totally or incompletely, and requiring tracheostomy even though miscellaneous complications, such as chronic bacterial colonization, disturbance of patient's speech and swallow, decreased cough ability, tracheomalacia, tracheal stenosis, perforation, tracheoesoph-ageal fistula, as well as painful tube changes and psychosocial disturbance, may occur. In order to avoid the inconvenience and complications of tracheostomy in long-term ventilator users, non-invasive IPPV has been introduced as an alternative to ventilate the patients with respiratory failure secondary to neuromuscular disease, but little experience has been reported on those individuals along with parenchymal lung disease. We presented a case with bronchiectasis, suspected central alveolar hypoventilation, and weak-ness of respiratory muscles. He suffered from respiratory insufficiency from recurrent infections and needed ventilatory support. Nasal IPPV(NIPPV) not only relieved his symptoms of hypoventilation, but also avoided the tracheotomy related complications. By the use of NIPPV, the patient was able to attend active rehabilitation program and got improved in his function level as well as life quality.

並列關鍵字

bronchiectasis ； nasal IPPV ； respiratory failure

國際替代計量

經鼻正壓呼吸器於支氣管擴張症併發呼吸衰竭患者之使用：病例報告

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