不同水平呼气末正压对急性心源性肺水肿预后的影响

Influence of Different Level Positive End-expiratory Pressure on Prognosis of Acute Cardiogenic Pulmonary Edema during Mechanical Ventilation

目的:探讨不同水平呼气末正压对急性心源性肺水肿预后的影响。方法:将65例急性心源性水肿行机械通气的患者随机分成低呼气末正压组(A组)和高呼气末正压组(B组),比较两组血气、CVP、BP、HR、尿量、X线胸片的变化和并发症。结果:通气治疗2 h后两组血气的变化,两组通气时间、不良事件的发生率的比较均无显著性差异(P>0.05),但通气过程中两组CVP、BP、HR的变化有显著性差异(P<0.05)。结论:呼气末正压水平的选择对急性心源性肺水肿机械通气治疗的预后无明显影响,低水平呼气末正压为更安全而有效的通气策略。

Objective: To explore the influence of different level positive end-expiratory pressure (PEEP) selection on prognosis of acute cardiogenic pulmonary edema during mechanical ventilation. Methods: 65 patients with acute cardiogenic pulmonary edema accepted invasive mechanic ventilation were divided into low level PEEP group (A group, n=34) and high level PEEP group(B group,n=31). The change of blood-gas analysis, CVP, blood pressure, heart rate, urine volume, chest X ray and complications were compared. Results: The change of blood-gas analysis after 2 hours mechanical ventilation and the time of ventilation, complication were no significant between the two groups, P > 0.05. The change of CVP,BP,HR during mechanical ventilation between the two groups was significant. Conclusions: The different level PEEP selection has no direct influence to the prognosis of acute cardiogenic pulmonary edema during mechanical ventilation. Low level PEEP is effective and safe for acute cardiogenic pulmonary edema.