Elliott M W, Steven M H, Phillips G D, Branthwaite M A
Department of Thoracic Medicine, Brompton Hospital, London.
BMJ. 1990 Feb 10;300(6721):358-60. doi: 10.1136/bmj.300.6721.358.
The value of mechanical ventilation using intermittent positive pressure ventilation delivered non-invasively by nasal mask was assessed in six patients with life threatening exacerbations of chronic respiratory disease. Median (range) arterial oxygen and carbon dioxide tensions were 4.4 (3.5-7.2) kPa and 8.7 (5.5-10.9) kPa respectively, with four patients breathing air and two controlled concentrations of oxygen. The arterial oxygen tension increased with mechanical ventilation to a median (range) of 8.7 (8.0-12.6) kPa and the carbon dioxide tension fell to 8.2 (6.5-9.2) kPa. Four patients discharged after a median of 10 (8-17) days in hospital were well five to 22 months later. One died at four days of worsening sputum retention and another after five weeks using the ventilator for 12-16 hours each day while awaiting heart-lung transplantation. This technique of mechanical ventilation avoids endotracheal intubation and can be used intermittently. Hypercapnic respiratory failure can be relieved in patients with either restrictive or obstructive lung disease in whom controlled oxygen treatment results in unacceptable hypercapnia. Respiratory assistance can be tailored to individual need and undertaken without conventional intensive care facilities.
采用经鼻面罩无创性给予间歇性正压通气进行机械通气的价值，在6例患有慢性呼吸道疾病危及生命的加重期患者中进行了评估。动脉血氧和二氧化碳分压的中位数（范围）分别为4.4（3.5 - 7.2）kPa和8.7（5.5 - 10.9）kPa，4例患者呼吸空气，2例患者吸入控制浓度的氧气。机械通气后动脉血氧分压升至中位数（范围）8.7（8.0 - 12.6）kPa，二氧化碳分压降至8.2（6.5 - 9.2）kPa。4例患者在住院中位数10（8 - 17）天后出院，5至22个月后情况良好。1例患者在第4天因痰液潴留恶化死亡，另1例患者在等待心肺移植期间，每天使用呼吸机12 - 16小时，5周后死亡。这种机械通气技术避免了气管插管，且可间歇性使用。对于控制性氧疗导致不可接受的高碳酸血症的限制性或阻塞性肺病患者，高碳酸性呼吸衰竭可得到缓解。呼吸支持可根据个体需求进行调整，且无需传统重症监护设施即可实施。
