机械通气治疗对急性心源性肺水肿患者血流动力学的影响

Hemodynamic effect of mechanical ventilation on acute cardiogenic pulmonary edema patients.

目的研究机械通气治疗对急性心源性肺水肿（ACPE）患者血流动力学的影响。方法30例ACPE患者均给予扩血管、利尿、强心等常规治疗。应用脉搏轮廓动脉压波形分析法测定胸腔血容积指数（ITBVI），全心舒张末期容积指数（GEDVI），心脏指数（CI），每搏指数（SI），全身血管阻力指数（SVRI），以及血管外肺水指数（EVLWI）；行动脉血气分析测定氧合指数（PaO2／FiO2）。其中12例接受机械通气治疗。为机械通气组，其余18例因拒绝或不耐受而未接受机械通气治疗为对照组。1h后复测上述指标。结果治疗1h后，机械通气组ITBVI、GEDVI、EVLWI与对照组比较明显降低（t值分别为2．1240、2．3971、2．9716．P均〈0．05）；机械通气组SI、PaO2／FiO2与对照组比较明显升高（t值分别为2．6267、3．1443，P均〈0．05）；CI、SVRI与对照组比较分别有所升高及降低，但差别无统计学意义（P均〉0．05）。结论在常规治疗基础上联合机械通气治疗可进一步改善ACEP患者血流动力学及氧合指标，改善心功能。

Objective To observe the hemodynamical effect of mechanical ventilation on acute cardiogenic pulmonary edema（ACPE）. Methods All of the cases were given conventional therapies including vasodilation, diuretics, cardiotonic therapy and so on. Intrathoracic blood volume index （ ITBVI）, global end -diastolic volume index （ GEDVI）, cardiac index （ CI）, stroke index（ SI）, systemic vascular resistance index （ SVRI ）, extravascular lung water index（EVLWI） ,were monitored by pulse index continuous cardiac output（picco）. Oxygenation index was monitored by blood gas analyzer. 12 eases, being additionally given mechanical ventilation therapy, were taken into mechanical ventilation（MV） group . The other 18 cases,having not undergone mechanical ventilation therapy because of refusing or being not tolerant of it because of any other reasons, were taken as control group. One hour later, the above-mentioned indexes were checked-up again. Results The ITBVI, GEDVI and EVLWI were significantly lowered one hour later in MV group compared with the corresponded indexes of control group （t values are 2. 1240,2. 3971, 2. 9716 ,P 〈 0.05 ） ;The SI, PaOE/FiO2 were obviously increased one hour later in MV group （t values are 2. 6267, 3. 1443 ,P 〈 0.05 ） ; But CI and SVRI didn＇t have any statistical differences in MV group（ P 〉 0.05 ）. Conclusion Mechanical ventilation therapy can significantly improve the hemodynamie and oxygenation indexes, especially improve heart function of ACEP patients,in addition to conventional therapy.