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respiratory failure

Respiratory dysfunction

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This entry is made by Compilation and application of scientific encyclopedia entries of "Science Popularization China" authentication.

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(Deputy Chief Physician) Review

Department of Respiratory and Critical Care Medicine, Peking University People's Hospital

Respiratory failure is caused by various reasons pulmonary ventilation And/or the ventilation function is seriously obstructed, so that effective gas exchange , leading to hypoxia with (or without) Carbon dioxide retention , resulting in a series of physiological function and Metabolic disorder Clinical syndrome. In Haiping University pressure Breathe indoor air under resting conditions and expel the heart Anatomical shunt And the arterial partial pressure of oxygen (PaO two ）Less than 8kPa (60mmHg), or accompanied by Partial pressure of carbon dioxide （PaCO two ）If it is higher than 6.65kPa (50mmHg), it is respiratory failure (hereinafter referred to as respiratory failure).

TCM disease name: respiratory failure
Foreign name: respiratory failure
Alias: Respiratory failure 、 acute respiratory failure 、 Chronic respiratory failure
Visiting department: Respiratory department, emergency department

Common causes: Respiratory disease, lung tissue disease, pulmonary vascular disease, thoracic disease
common symptom: In addition to the primary symptoms, it is mainly hypoxia and carbon dioxide retention
infectivity: nothing

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pathogeny

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1. Respiratory disease

Bronchitis, bronchospasm, foreign bodies, etc. block the airway, causing insufficient ventilation, Gas distribution Unevenness leads to imbalance of ventilation/blood flow ratio, hypoxia and carbon dioxide retention.

2. Pulmonary tissue lesions

pneumonia , Severe pulmonary tuberculosis 、 emphysema Dispersion pulmonary fibrosis 、 Adult respiratory distress syndrome (ARDS), which may cause Lung capacity The decrease of ventilation volume and effective diffusion area, and the imbalance of ventilation/blood flow ratio lead to pulmonary artery like shunt, resulting in hypoxia and/or carbon dioxide retention.

3. Lung vascular disease

lung Vascular embolism 、 Pulmonary infarction So that part of venous blood flows into pulmonary vein , hypoxia occurs.

four chest pathological changes

Such as thoracic trauma, surgical trauma pneumothorax and Pleural effusion And affect thoracic activities and lung Dirt expansion leads to ventilation reduction, inhaling gas unevenness and affecting ventilation function.

five Nervous center And Conduction system Respiratory muscle disease

Cerebrovascular Lesions encephalitis 、 Brain trauma 、 Drug poisoning Etc. direct or Indirect inhibition Respiratory center; poliomyelitis as well as Polyneuritis The block of muscular nerve junction caused by this disease affects the conduction function; myasthenia gravis And other damages to respiratory dynamics, resulting in insufficient ventilation.

clinical manifestation

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1. Classification

(1) Press Arterial blood gas Analysis and classification ① Type I respiratory failure hypoxia without CO two Retention, or with CO two Decrease (type I) is seen in Ventilatory dysfunction (imbalance of ventilation/blood flow ratio, impairment of diffusion function and pulmonary arteriovenous shunt). ② Type II respiratory failure O deficiency caused by insufficient alveolar ventilation two And CO two Retention, simple insufficient ventilation, O deficiency two And CO two The degree of retention of two More serious. Only increase Alveolar ventilation , add if necessary Oxygen therapy To correct.

(2) Classification by disease course According to the course of disease, it can be divided into acute and chronic. Acute respiratory failure refers to the clinical manifestation of sudden respiratory failure caused by the above five categories of causes, which causes serious damage to ventilation or ventilation function, such as Cerebrovascular accident 、 Drug poisoning inhibition Respiratory center 、 Respiratory muscle Paralysis Pulmonary infarction 、 ARDS If not rescued in time, the patient's life will be endangered.

Chronic respiratory failure is more common in chronic respiratory diseases, such as Chronic obstructive pulmonary disease , Severe pulmonary tuberculosis Etc., which respiratory function The damage gradually increased, although there was a lack of O two Or with CO two Retention, but can still engage in daily activities through compensatory adaptation of the body.

2. Symptoms

In addition to the primary symptoms, it mainly includes hypoxia and Carbon dioxide retention Performance, such as dyspnea , shortness, psychoneurological symptoms, etc., complicated Pulmonary encephalopathy When, there may also be Gastrointestinal bleeding 。

3. Physical examination

Available lips Cyanosis of nail bed Consciousness obstacle , Ball Conjunctival congestion , edema Flapping wing tremor 、 Edema of optic nerve papilla Etc.

inspect

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one Blood gas analysis

Resting state When aspirating air Arterial partial pressure of oxygen （PaO two ）<8.0Kpa (60mmHg) arterial blood partial pressure of carbon dioxide (PaCO two ）>6.7Kpa (50mmHg) is type II respiratory failure, and simple decrease of arterial partial pressure of oxygen is type 1 respiratory failure

two electrolyte inspect

Respiratory acidosis with metabolic acidosis Is often accompanied by Hyperkalemia ； Respiratory acidosis combined with metabolic alkalosis There are often low potassium and Hypochloremia 。

3. Sputum examination

Sputum smear The results of the test with bacterial culture are conducive to guiding drug use.

4. Other inspection

as Pulmonary function test , Chest Imaging According to the different primary diseases, there are corresponding findings.

diagnosis

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Main disease Diagnostic basis , acute, such as drowning, electric shock, trauma Drug poisoning Severe infection and shock; Chronic often secondary to chronic Respiratory diseases , such as Chronic obstructive pulmonary disease Etc. The combination of clinical manifestations and blood gas analysis is helpful for diagnosis.

treatment

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1. First, actively treat the primary disease, and use sensitive antibiotics when combined with bacterial infection to remove the inducing factors.

2. Keep respiratory tract Smooth and effective Ventilatory capacity , can be cancelled Bronchospasm And expectorant drugs, such as Salbutamol (Shuchuanling) Terbutaline sulfate (Bolikanni) spasmolysis, Acetylcysteine 、 Ambroxol hydrochloride （ Mucosolvan ）And other drugs for expectoration. Available if necessary Adrenocortical hormone Intravenous drip 。

3. Correction Hypoxemia , available Nasal catheter Or mask oxygen inhalation, severe hypoxia and carbon dioxide retention, severe Consciousness obstacle , appears Pulmonary encephalopathy Should be used mechanical ventilation To improve hypoxemia.

4. Correct acid-base imbalance Arrhythmia 、 heart failure etc. complication 。

prevention

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1. Decrease Energy consumption

relieve a bronchial tube Spasm, eliminate bronchial mucosa edema, reduce bronchial secretions airway resistance , reduce energy consumption.

2. Improve the body Nutritional status

Enhance nutrition, increase intake of sugar, protein and various vitamins, if necessary Intravenous drip reunite with amino Drum, plasma albumin 。

3. Keep exercising

Daily Breathing gymnastics , Enhanced Respiratory muscle Active function of.

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