探討非侵襲性呼吸器使用在急性呼吸衰竭病人之臨床價值

Clinical Value of Non-invasive Positive Pressure Ventilators in Patients with Acute Respiratory Failure

董慧萍(Hui-Ping Tung) ； 吳漢屏(Han-Ping Wu)

《Journal of Emergency Medicine, Taiwan》 11卷4_S期 (2009/12) Pp. s14-s19

摘要

背景：急性呼吸衰竭在急診發生率並不低，使用非侵襲性呼吸器取代傳統插管的治療在國外曾被探討過，但在國內的相關研究並不多。因此，本研究乃探討非侵襲性呼吸器使用於急性呼吸衰竭病人之成功與失敗的相關因素，以提供臨床醫師在臨床使用上參考的準則。
方法：本研究以回溯性收集自2006年1月至2008年6月，於本院急診室發生急性呼吸衰竭的病人，分析病患使用侵襲性呼吸器及非侵襲性呼吸器之臨床差異性，並分析病人在使用非侵襲性呼吸器後之死亡率、住院天數、疾病別，以及分析因不同病因使用非襲性呼吸器的效果與預後。
結果：本研究共收案203位在急診室呈現急性呼吸衰竭個案，需立即插管之個案族群死亡率為29%、平均住院天數為10.7±4.0天，其中以肺癌、肺炎、敗血症所造成之個案佔較多數；而使用非侵襲性呼吸器族群之死亡率為48%，住院天數為12.3±5.0天，其中以敗血症及肺癌所引發之個案佔最多。在使用非侵襲性呼吸器而成功存活之個案族群，其平均住院天數為4.8±4.0天，並因多以肺水腫及慢性阻塞性肺病個案為主。
結論：本研究提供急診醫師有關非侵襲性呼吸器使用於肺水腫及慢性阻塞性肺病的個案成功率較高，使用非侵襲性呼吸器也確實能降低病患住院天數。但是對於敗血症、肺炎、肺癌等所引發呼吸衰竭之個案，還是會有再被插管的可能，不僅延長住院天數甚至增加死亡率。

關鍵字

非侵襲性呼吸器 ； 急性呼吸衰竭 ； 氣管內管插管 ； 正壓呼吸器

並列摘要

Background: Noninvasive positive-pressure ventilation (NIPPV) is a type of mechanical ventilation that does not require an artificial airway. There are few studies on the use of NIPPV in patients with acute respiratory failure (ARF) in Taiwan. Therefore, this study analyzed the clinical value of NIPPV in patients with ARF.
Methods: From January 2006 to June 2008, we retrospectively collected 203 patients with ARF who received either NIPPV or conventional invasive ventilator treatment in the emergency department (ED). We analyzed patient characteristics, possible etiologies, severity, duration of hospitalization, and mortality between patients with ARF using NIPPV and those using conventional ventilators.
Results: In the endotracheal intubation group, the mortality rate was 29 percent and the length of hospital stay was 10.7 ± 4.0 days. The major etiologies included pneumonia, lung cancers and sepsis. But, in the NIPPV group, the mortality rate was 26 percent and the length of hospital stay was 7.8 ± 5.0 days. The major etiologies were pulmonary edema and chronic obstructive pulmonary disease (COPD). Higher mortality rates (48%) and the longer hospital stays (12.3 ± 5.0 days) were noted in patents who failed NIPPV controls.
Conclusion: We provided experience in clinical application of NIPPV in patients with ARF admitted to the ED. Successful control of ARF by NIPPV may reduce the mortality rate and shorten the duration of hospitalization, especially in patients with ARF caused by pulmonary edema, and COPD. However, those with sepsis and lung cancer may have a higher mortality rate.

並列關鍵字

clinical value ； NIPPV ； non-invasive ； ventilator ； respiratory failure