Chabot F, Cornette A, Robert V, Vial B, Polu J M
Service des Maladies Respiratoires et Réanimation Respiratoire, CHU Nancy Brabois, 54500 Vandoeuvre-les-Nancy, France.
Rev Mal Respir. 2001 Jun;18(3):267-82.
In the course of chronic respiratory insufficiency, acute episodes often require the use of mechanical ventilation. Failure of weaning, or worsening of alveolar hypoventilation, results in long term ventilatory assistance with the need of overall care of the patient. The pneumologist has a key role in the choice of indications, devices and mode of home mechanical ventilation. Thanks to the non-invasive ventilation with a facial or nasal mask, tracheostomy is less often needed. Respiratory failure due to lung restriction is the best indication of mechanical ventilation. The results in COPD are questionable. Whatever to the technique of ventilation and the underlying disease, the pneumologist has to ascertain the steady state of the medical condition, patient and family education, and social situation, all factors to be taken into account before the patient can be discharged. Knowing the specific needs in these patients'care, the pneumologist plays a key role at each stage of home return and follow-up. He co-ordinates the different aspects of pneumological care, like rehabilitation and acute episodes treatment. The overall care of the patients should be improved by the development of health networks in the field of chronic respiratory insufficiency.
在慢性呼吸功能不全的病程中，急性发作常常需要使用机械通气。撤机失败或肺泡通气不足恶化，会导致长期通气支持，并需要对患者进行全面护理。肺科医生在家庭机械通气的适应证选择、设备及模式方面起着关键作用。由于可使用面罩或鼻罩进行无创通气，气管切开术的需求减少。因肺限制性疾病导致的呼吸衰竭是机械通气的最佳适应证。慢性阻塞性肺疾病（COPD）患者使用机械通气的效果存在疑问。无论采用何种通气技术及潜在疾病如何，肺科医生都必须确定病情的稳定状态、对患者及家属进行教育，并了解社会状况，在患者出院前所有这些因素都需考虑在内。了解这些患者护理中的特殊需求后，肺科医生在患者回家及随访的每个阶段都起着关键作用。他协调肺科护理的不同方面，如康复和急性发作的治疗。慢性呼吸功能不全领域健康网络的发展应能改善对患者的全面护理。
