无创通气治疗急性肺水肿的临床研究

Clinical study on treatment of acute cardiogenic pulmonary edema by noninvasive mechanical ventilation

目的:评价无创正压通气治疗急性心原性肺水肿的疗效。方法:将急性肺水肿(ACPE)60例患者随机分为常规治疗组和NMV组。NMV组患者在常规药物治疗基础上,通过面罩与呼吸机相连,加用无创通气治疗,常规治疗组给予面罩吸氧。在治疗前后分别测量血气及血压、心率、呼吸频率等临床指标,将数据进行比较。结果:NMV组30例患者有5例改行气管插管,对照组30例12例改行气管插管。NMV组的症状缓解时间40(5～77)min明显短于对照组145(49～263)min,NMV在第1个2h内迅速改善氧合。结论:与常规治疗相比,应用无创机械通气治疗急性心原性肺水肿能快速改善氧合、动脉血二氧化碳分压及呼吸困难,减少气管插管,值得在临床推广使用。

Objective：To estimate the efficacy of non-invasive positive pressure ventilation（NIPPV） in the treatment of the patients with acute cardiogenic pulmonary edema（ACPE）. Methods ：60 patients were randomly assigned to receive conventional oxygen therapy or NMV supplied by a standard ventilator through a face mask, with noninvasives mechanical ventilation in the treatment. Blood gas and vital signs were obtained forehead. Results ：Endotracheal intubation was required in 5 of 30 patients assigned to receive NMV and in 12 of 29 assigned to receive conventional oxygen therapy. Resolution time was significantly shorter in the NMV group median40 （5 ± 77） vs 145 （49 ±263） min （P〈 0. 01）, NMV led to a rapid improvement in oxygenation in the first 2h. There were no differences in hospital and ICU length of stay or mortality. Conclusion：In this study of acute cardiogenic pulmonary edema, NMV is superior to conventional oxygen therapy. It can be recommended for clinical use.