镇静麻醉条件下有创机械通气治疗重症急性肺水肿的理论基础及5例临床分析

Theoretical Basis for tile Treatment of Critical Acute Pulmonary Edema with Invasive Mechanic Ventilation Under Sedation or Anesthesia and Clinical Analysis of 5 Cases

传统急性肺水肿（APE）病理生理研究中，忽略了肺水肿发生后呼吸动力学改变对APE的促进作用。忽略肺水肿后缺氧以及患者精神，神经因素致内源性儿茶酚胺分泌增加对APE控制的不利影响，从而在治疗中仅仅关注引起APE的心血管因素，忽略了APE后呼吸动力学和神经内分泌改变会成为APE恶性循环的原因。近年来国外对机械通气（MV）应用于APE的研究表明，机械通气能够迅速改变APE后不利的呼吸动力学状况，在改善呼吸功能的同时改善心功能。并通过麻醉镇静剂的应用以及改善缺氧，阻断内源性儿茶酚胺分泌增加对APE的不利作用。随着机械通气技术逐步普及，MV应该成为APE抢救中的重要措施，为对于重症APE，有创通气优于无创通气。

The traditional theyapy of acute pulmonary edema（APE） emphaits on the cardiovascular aspect but ignore that the changes in pneumodynamics and neuroendocrine will become the reason of vicious cycle in APE, Recent forergn researches on the applicant of mechanical ventilation（MV） to treat APE indicates MV can change the adverse pneumodynamics status after APE, and improved the respiratory funcgon and the head function instantly. Application of anesthetic drug can ameliorate hypoxia, and inhibg the disadvantage effects of in creased endogenous catecholamine.With the development and prevalence of MV, it will become an imbedant measure in rescuing the APE. and the invasive mechanical ventilation is better than non-invasive ventilation for critical APE.