14:15,7,Jul,2009 | (1113/0/0) | Original

chronic hypoxic respiratory failure

The clinical manifestations of chronic respiratory failure: including the original primary clinical manifestations of disease and lack of oxygen, carbon dioxide retention caused by various organ damage. Oxygen and carbon dioxide retention depends not only on the harm to the body oxygen and carbon dioxide retention level, but also depends on the oxygen and carbon dioxide retention rate of occurrence and duration, so when acute exacerbated chronic respiratory failure, the lack of oxygen and carbon dioxide retention dramatically, so this is often more severe clinical manifestations. Hypoxia and hypercapnia on the body damage vary, but there is considerable overlap, for a respiratory failure is concerned, the clinical manifestations are often shown lack of oxygen and carbon dioxide retention is a result of the role. Therefore, the following oxygen and carbon dioxide retention will be caused by integrated with the clinical manifestations to be described. 1. Respiratory dysfunction and carbon dioxide retention, hypoxia can affect the respiratory function. Breathing difficulties and respiratory rate is often faster clinically important symptoms first appeared. Manifested as respiratory effort, with respiratory frequency to speed up, breathing shallow, nose flap, secondary muscles involved in breathing, especially in COPD patients with airway obstruction, respiratory pump failure factors, difficulty in breathing becomes more apparent. Sometimes there may be respiratory rhythm disturbance, the performance of Chen Shi breathing, sighing like breathing, mainly seen in the respiratory center by the suppression. Respiratory failure does not necessarily have breathing difficulties, severe respiratory depression when they occur.
2. Cyanosis is a reliable signs of hypoxemia, but not sensitive enough. Over the past that the blood reduced hemoglobin 50g / L had cyanosis view has been rejected. Indeed, when Pa0250mmHg, oxygen saturation (Sa02) 80%, they can appear cyanotic. Tongue cyanosis over lips, nail beds appeared much earlier and more evident. Cyanosis depends on the degree of hypoxia, but also by hemoglobin, skin pigmentation and cardiac functional status.
3. Neuropsychiatric symptoms of mild hypoxia can have difficulty concentrating, disorientation; severe hypoxia are associated with carbon dioxide retention, especially when there may be headache, excitement, depression, drowsiness, convulsions, loss of consciousness or even coma. Chronic pulmonary disease with acute respiratory failure due to worsening hypoxemia and carbon dioxide retention occurs rapidly, so there may be significant neuropsychiatric symptoms, then, can be called pulmonary encephalopathy.
4. Cardiovascular dysfunction severe hypercarbia and hypoxia can cause palpitations, conjunctival congestion and edema, arrhythmia, pulmonary hypertension, right heart failure, and hypotension.
5. Digestive symptoms â‘  ulcer symptoms; â‘¡ upper gastrointestinal bleeding; â‘¢ a
bnormal liver function. The change and carbon dioxide retention, severe hypoxia related.
6. Renal complications of renal failure may occur, but mostly functional renal insufficiency, severe carbon dioxide retention, hypoxia can occur with advanced renal failure.
7. Acid-base imbalance and electrolyte imbalance is often due to respiratory failure hypoxia and / or carbon dioxide retention, and clinical application of corticosteroids, diuretics, and anorexia and other factors which may be complicated by acid-base imbalance and electrolyte disturbance. Common abnormal arterial blood gas and acid-base balance types are: ① severe hypoxia with respiratory acidosis (respiratory acidosis); ② severe hypoxia associated with respiratory acidosis and metabolic alkalosis (metabolic alkalosis); ③ with severe hypoxia with respiratory acidosis and metabolic acidosis (acidosis); ④ hypoxia with respiratory alkalosis (respiratory alkalosis); ⑤ hypoxia associated with respiratory alkalosis and metabolic alkalosis; ⑥ hypoxia associated with triple acid-base imbalance.
chronic hypoxic respiratory failure

Respiratory failure
Section I Introduction
Respiratory failure (respiratory failure) of various causes lung ventilation and (or) ventilation with severe dysfunction, resulting in the resting state can not maintain adequate gas exchange, leading to hypoxia with (or without) of carbon dioxide retention, which led to a series of physiological functions and metabolic disorders in the clinical syndrome. Clinical manifestations of dyspnea, cyanosis and so on.
Clinically, respiratory failure there are several classifications:
※ Jihuan divided according to disease
Chronic respiratory failure: respiratory dysfunction gradually worsened, resulting in oxygen and carbon dioxide retention. Compensation due to the body, most patients can adapt to, the patient can still engage in daily life. Common in COPD, ILD, such as severe pulmonary TB.
Acute respiratory failure: Due to unexpected events, respiratory failure caused by respiratory depression, such as laryngeal edema, foreign bodies, such as obstructive airway sputum. (Death)
Acute exacerbation of chronic respiratory failure:
※ divided by arterial blood gas: Ⅰ and Ⅱ type of respiratory failure in respiratory failure (arterial blood gas to use more current points system.)
Definition: normal atmospheric pressure at sea level, resting, breathing air conditions, PaO2 <60mmHg and / or PaCO2> 50mmHg, and the exclusion of intracardiac anatomy in shunt and primary factors such as cardiac output decreased, that is respiratory failure.
(1) The two types of arterial blood gas analysis
1. â…  type: oxygen without carbon dioxide retention (PaO2 <60mmHg, PaCO2 decreased or normal).
2. â…¡ type: CO2 retention with hypoxia (PaO2 <60mmHg, PaCO2> 50mmHg).
Section II chronic respiratory failure
First, the oxygen and carbon dioxide retention of the mechanisms of
â‘´ hypoventilation
⑵ ventilation / perfusion imbalance V / Q ≈ 0.8
⑶ pulmonary artery - vein-like shunt
â‘· diffusion barrier
⑸ oxygen consumption ↑
Second, the clinical manifestations:
â‘´ breathing difficulties
⑵ cyanosis
Neuropsychological symptoms ⑶
â‘· blood circulation system
⑸ symptoms of digestive and urinary system
Third, the diagnosis:
Chronic respiratory failure when the change is typical of arterial blood gas PaO2 <60mmHg, may be with or without PaCO2> 50mmHg, with associated clinical PaCO2> 50mmHg (â…¡ type respiratory failure) is common.
IV treatment:
1. To establish a patent airway
2. Oxygen therapy
3. To increase ventilation to reduce carbon dioxide retention
â‘´ respiratory stimulant
⑵ mechanical ventilation
4. Correct the acid-base balance and electrolyte disorders
5. Anti-infective therapy (primary disease treatment)
6. Complication prevention
7. Nutrition
Section III acute respiratory distress syndrome (ARDS)
ARDS is the original heart and lung function in patients with normal pulmonary and extrapulmonary disease due to sudden severe blow to cause acute pulmonary edema and progressive hypoxic respiratory failure, such as severe shock, trauma, infection, drowning, poisoning and so on. If not treated, mortality 50%. The main pathological changes of the lung capillary endothelial and alveolar epithelial cell injury, especially in alveolar type â…¡ epithelial cells, leading to increased pulmonary vascular permeability and pulmonary surfactant reduced, resulting in pulmonary edema and atelectasis, and the results of lung V / Q imbalance, severe hypoxemia, â… -type respiratory failure.
First, the acute respiratory distress syndrome (acute respiratory distress syndrome) diagnostic criteria:
1. A disease caused by the original ARDS, acute onset
2. Respiratory rate> 28 beats / min
3. Hypoxemia:
1) The oxygen concentration of 21%, paO2 <60mmHg (Pa 45mmHg)
2) oxygenation index: PaO2 / FiO2 <200 (PaO2 / FiO2 <300 ALI)
3) P (A-a) O2> 100mmHg
4) absorption of 100% oxygen, PaO2 <300mmHg
4.X-ray film and see the flaky opacities exudative
5. Pulmonary capillary wedge pressure (PCWP) ≤ 18mmHg, or clinical out cardiogenic pulmonary edema.
Second, treatment
(A) oxygen
(B) mechanical ventilation, PEEP
(C) maintain proper fluid and electrolyte balance
(D) active treatment based on disease
A1-type questions
2000-2-11. Respiratory failure diagnostic criteria of blood gas
A. arterial oxygen content of less than 9mmol / L
B. Arterial oxygen saturation (SaO2) below 90%
C.pH value <7.35
D. arterial carbon dioxide partial pressure (PaC02) higher than 50mmHg
E. arterial oxygen tension (PaO2) less than 60mmHg
Answer: E
2002-2-122. Respiratory failure is the most important clinical manifestations
A. respiratory effort associated with prolonged expiratory
B. faster respiratory rate
C. dyspnea and cyanosis
D. Neuropsychiatric symptoms
E. large number of lung auscultation
Answer: C
2002-3-4. Diagnosis of chronic respiratory failure is based on the most important
A. dyspnea, cyanosis and other symptoms
B. disturbance of consciousness with chemosis
C.SaO2 <90%
D.PaO2 <80mmHg, PaCO2> 50mmHg
E.PaO2 <60mmHg, or associated with PaCO2> 50mmHg
Answer: E
2003-1-72 women, aged 55, chronic obstructive pulmonary disease (COPD) emphysema-type patients. In recent years, activities, and feeling a slight shortness of breath, cough, light, sputum less. Blood gas: PaO2 36mmHg, PaCO2 70mmHg. The development of the disease have occurred in patients with COPD
A.I respiratory failure
B. II respiratory failure
C. Hypoxemia
E. None of the above
Answer: B
2003-1-73. According to the results of blood gas analysis, the patient's respiratory function disorder
A. ventilation dysfunction
B. ventilation dysfunction
C. coexistence of ventilation and ventilatory dysfunction
D. alveolar membrane thickening due to decreased diffusion capacity
E. ventilation / perfusion ratio decreased
Answer: C
B1-type questions
(Alternative answers common questions 81-83)
A.pH7.38, PaO250mmHg, PaCO240mmHg
B.pH7.30, PaO250mmHg, PaCO280mmHg
C.pH7.40, PaO260mmg, PaCO265mmHg
D.pH7.35, Pa0280mmHg, PaCO220mmHg
E.pH7.25, Pa0270mmHg, PaCO230mmHg
The blood gas analysis was consistent with
2000-2-81. Compensatory respiratory acidosis
Answer: C
2000-2-82. Compensatory metabolic acidosis
Answer: D
2000-2-83. Decompensated respiratory acidosis
Answer: B
(145-146 alternative answers common questions)
A.PaO2 to 50mmHg, PaCO2 was 40mmHg
B.PaO2 to 55mmHg, PaCO2 was 50mmHg
C.PaO2 to 65mmHg, PaCO2 was 40mmHg
D.PaO2 to 70mmHg, PaCO2 was 40mmHg
E.PaO2 to 70mmHg, PaCO2 was 45mmHg
2003-1-145. I respiratory failure consistent with arterial blood gas criteria
Answer: A
2003-1-146. II respiratory failure consistent with arterial blood gas criteria
Answer: B

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