鼻面罩双水平压力支持呼吸机在老年急性心源性肺水肿的临床应用

The use of bilevel positire airway ventilation in the treatment of older patients with acute cardiogenic pulmonary edema

目的观察应用双水平压力支持呼吸机(bilevelpositiveairwayventilation,BiPAP)无创通气治疗老年急性心源性肺水肿的临床价值。方法将52例老年急性心源性肺水肿患者随机分为两组,观察组除常规抗心衰治疗外加用BiPAP无创通气,对照组采用常规抗心力衰竭治疗。观察组观察通气前后心率、呼吸频率、血氧饱和度、血气分析和血压的变化。比较观察组和对照组的气管插管率。结果观察组患者经过1～8小时的BiPAP无创通气治疗后,心率和呼吸频率明显减慢(P<0.01),动脉血氧分压和动脉血氧饱和度明显提高(P<0.01),动脉血二氧化碳分压和平均动脉压明显下降(P<0.01),心功能明显改善,气管插管率明显降低(P=0.004)。结论老年急性心源性肺水肿应用BiPAP无创通气治疗可明显改善患者的低氧血症和心功能,降低患者的气管插管率,是抢救急性心源性肺水肿的一种安全有效的方法。

Objectives To evaluate the clinical applications of bilevel positive airway ventilation (BiPAP) ventilation in the older patients with acute cardiogenic pulmonary edema(ACPE). Methods All patients received oxygen 5～10 L/min, furosemide 40 mg iv, morphine 3 mg im, and nitroglycerin iv drip. Thereafter patients were randomly divided into two groups. 1.The noninvasive nasal mask BiPAP ventilation. 2. Continue nitroglycerin iv drip. Results After BiPAP therapy, the heart rate , breathing rate , arterial partial pressure of carbon dioxide ( PaCO2 ) and mean artery pressure ( MAP) in patients of group 1 were reduced significantly(P<0.01), partial pressure of oxygen ( PaO2 ) and arterial saturation of oxygen (SaO2 )were markedly increased (P<0.01) than those of group 2. The cardiac function in all patients was improved. The incidence of endotracheal intubation was reduced (P=0.004). Conclusions The noninvasive nasal mask BiPAP is a kind of safe and effective method in the treatment of elderly patients with ACPE. It can improve hypoxemia and cardiac function and reduce the incidence of endotracheal intubation .