双水平正压通气治疗急性心源性肺水肿

Bi-level Positive Airway Pressure Ventilation Therapy for Acute Cardiogenic Pulmonary Edema

目的探讨应用双水平无创正压机械通气技术治疗急性心源性肺水肿(ACPE)的临床价值。方法将2004年7月—2006年5月收治的44例急性心源性肺水肿病人随机分为BiPAP组和面罩吸氧组。BiPAP组在常规药物治疗基础上,经鼻面罩连接BiPAP呼吸机,吸气末压力(IPAP)8cmH2O^15cmH2O、呼气末压力(EPAP)2cmH2O^5cmH2O,吸氧浓度28%~35%;面罩吸氧组在常规药物治疗的基础上单纯给予Venturi面罩吸氧。监测病人心率、血压、呼吸、指端血氧饱和度、动脉血气分析和临床变化。结果BiPAP组经无创机械通气后所有病人呼吸频率减慢,心率下降,呼吸困难缓解,治疗总有效率为100.0%。对血压无明显影响。呼吸困难开始缓解时间40min(10min^100min),明显短于对照组的150min(50min^240min)(P<0.01)。对照组在相应时间治疗有效率仅为64.7%。结论充分使用药物治疗急性心源性肺水肿基础上,合用BiPAP治疗可使肺水肿和心功能迅速改善,减少气管插管率。

Objective To evaluate lation （BiPAP） for acute bilevel positive airway pressure ventic pulmonary edema. Methods Forty-four patients （pts） were assigned to control group and BiPAP group randomly. In BiPAP group, 27 pts were linked to BiPAP by a nose - face mask accessory with conventional drug. The aspiratory pressure and expiratory pressure were 8 cmH2O- 15 cmH2O and 2 cmH2O- 5cmH2O, respectively. The oxygen density was 28% - 35 %. In control group, 17 pts were treated with traditional drug. The electrocardiography, arterial oxygen saturation heart rate and blood pressure were observed during the therapy. Results Dyspnea were relieved in all pts in BiPAP group. Both the respiratory rate and heart rate were slowed. There were no changes in blood pressure. The effective rate was 100.0% in BiPAP group and that in control group was 64.7%. Conclusion The BiPAP for acute cardiogenic pulmonary edema was superior to conventional oxygen therapy. It should be recommended for clinical use.