短期Bi-PAP通气治疗老年急性心源性肺水肿

Treatment of Short-time Bi-level Positive Airways Pressure in Elderly Patients with Acute Cardiogenic Pulmonary Edema

【目的】观察短期Bi-PAP通气治疗老年急性心源性肺水肿临床疗效。【方法】老年急性心源性肺水肿病人23例,随机分为常规治疗组12例,Bi-PAP组11例,比较Bi-PAP通气及常规吸氧治疗的疗效,并观察Bi-PAP通气对心脏功能的影响。【结果】Bi-PAP通气组经治疗后,30 min至3 h后呼吸困难开始好转,最快10 min,血气指标改善多在1~3 h。常规治疗组治疗后2~4 h呼吸困难好转,血气指标改善多在3~4h;两组比较,Bi-PAP组治疗有效率及达到有效所需时间优于常规治疗（P〈0.05）,好转率差异无显著性,但达到好转所需时间短（P〈0.05）,气管插管率差异无显著性。Bi-PAP组3例病人发生面罩局部皮肤损伤,常规治疗组无并发症发生（P〈0.05）。使用Bi-PAP通气治疗4 h后,左室射血分数及E/A差异无显著性,但后Tei较上机前有提高（P〈0.05）。【结论】早期应用Bi-PAP可较快地缓解心源性肺水肿的临床症状,并可改善心脏功能。

[Objective]To investigate the role of hi-level positive airway pressure（hi-PAP） mechanical ventilation in treatment of elderly patients with acute cardiogenic pulmonary edema. [Methods]Twenty three elderly patients with acute cardiogenic pulmonary edema were randomly assigned to conventional oxygen therapy or Bi-PAP mechanical ventilation,effects of the two treatment ways,the role of Bi-PAP on heart function were investigated.[Results]In Bi-PAP group, after the administration of ventilation, the dyspnea was reduced in 30min-3 h, blood gas index improved in 1-3h. In conventional oxygen therapy group, the dyspnea was reduced in 1-3 h, blood gas index improved in 3-4 h. In Bi-PAP group, effective rate was higher, but the time needed to improve was shorter,3 patients developed minor facial erythema as a result of the face mask, Tel increased after treatment. [Conclusion]In elderly patients with acute cardiogenic pulmonary edema, noninvasive ventilation can decrease pulmonary edema more quickly, at the same time, improve heart function.