Peigang Yin, Marini John J
Pulmonary Department, Regions Hospital, St. Paul, Minnesota 55101, USA.
Curr Opin Crit Care. 2002 Feb;8(1):70-6. doi: 10.1097/00075198-200202000-00011.
Ventilatory intervention is often life-saving when patients with asthma or chronic obstructive pulmonary disease (COPD) experience acute respiratory compromise. Although both noninvasive and invasive ventilation methods may be viable initial choices, which is better depends upon the severity of illness, the rapidity of response, coexisting disease, and capacity of the medical environment. In addition, noninvasive ventilation often relieves dyspnea and hypoxemia in patients with stable severe COPD. On the basis of current evidence, the general principles of ventilatory management common to patients with acutely exacerbated asthma/COPD are these: noninvasive ventilation is suitable for a relatively simple condition, but invasive ventilation is usually required in patients with more complex or more severe disease. It is crucial to provide controlled hypoventilation, longer expiratory time, and titrated extrinsic positive end-expiratory pressure to avoid dynamic hyperinflation and its attendant consequences. Controlled sedation helps achieve synchrony of triggering, power, and breath timing between patient and ventilator. When feasible, noninvasive ventilation often facilitates the weaning of ventilator-dependent patients with COPD and shortens the patient's stay in the intensive care unit.
当哮喘或慢性阻塞性肺疾病（COPD）患者出现急性呼吸功能不全时，通气干预往往能挽救生命。尽管无创和有创通气方法都可能是可行的初始选择，但哪种方法更好取决于疾病的严重程度、反应速度、并存疾病以及医疗环境的能力。此外，无创通气通常能缓解稳定期重度COPD患者的呼吸困难和低氧血症。根据目前的证据，急性加重期哮喘/COPD患者通气管理的一般原则如下：无创通气适用于病情相对简单的情况，但病情更复杂或更严重的患者通常需要有创通气。提供控制性低通气、延长呼气时间以及滴定式外部呼气末正压以避免动态肺过度充气及其相关后果至关重要。控制性镇静有助于实现患者与呼吸机之间触发、功率和呼吸时间的同步。在可行的情况下，无创通气通常有助于依赖呼吸机的COPD患者撤机，并缩短患者在重症监护病房的住院时间。
