![急诊临床路径](https://wfqqreader-1252317822.image.myqcloud.com/cover/11/36535011/b_36535011.jpg)
上QQ阅读APP看书,第一时间看更新
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=1738927876-dSZwsdOdfdzFmGlonGxCU5LXg1zLLh9Z-0-eb8ed9867200c6496a30699e2d036024)
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=1738927876-HBFhaxyY6o5vLxvJPU8GWHBP0hctht6o-0-49c9a1273ffbfbd8fc8204601b708fad)
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=1738927876-9jB4ruReTlUuvvuW0cFL9uHA7lj0OJc4-0-58ce881726bda6fc4b53d5f7ffd1c865)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.3_1_59669.jpg?sign=1738927876-3cdIPtzrA3gteibR9fBjcFx9p7S2uJCZ-0-a85237f21b65fe70311711ed2dde1d89)
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=1738927876-6qcpDpkzzSQCZjS0WNBMCrS6ec0GpQ6g-0-f0f006fbac9f9bf55eec7dd512279b44)
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=1738927876-tewqs7RCRvqJphmM7XnC1jJ1VTEai2bb-0-8790003914a81ab936365bb3e4ba7a24)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.5_1_59991.jpg?sign=1738927876-Z1CGT2UrZcxvlWdUzVDBxFIRZishhiHT-0-596d0d7b7619f934b41c053dad77a729)
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=1738927876-d8juGMV0FoUAoRyaKGfsGT7BgPYq2jtj-0-0239276029fd2cd89fd0a3f50b72ee0c)
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=1738927876-vOurZHA2A1IYOUcvUBB0Y1RicclcbUKr-0-e1e3107378a771fcfb6046774de8017e)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_1_59673.jpg?sign=1738927876-AivClpLrLF2xTm31cgJLJ3iQdoyJmzpN-0-79bc0557c40dd9516a2db581f355dd68)
续表
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.7_2_14499.jpg?sign=1738927876-eLWTZJ853Ho2rF4Fofa0f0IjB5779Dtu-0-d6c024d0d246a42735f9d07d15d438ae)
表17.8 给氧装置
![](https://epubservercos.yuewen.com/1C1403/19400084308706906/epubprivate/OEBPS/Images/T17.8_59674.jpg?sign=1738927876-FJPmwwiaizaEMZTStnn0N2bEu5uwFumX-0-76bc181eaeb5802ab29031adee021b3c)