无创正压通气治疗急性心源性肺水肿28例临床分析

Clinical study on non-invasive positive pressure ventilation for 28 cases with acute cardiogenic pulmonary edema

目的:探讨无创正压通气(NIPPV)治疗急性心源性肺水肿(ACPE)的临床疗效。方法:回顾性分析我院NIPPV治疗ACPE28例患者的资料。其中持续气道正压通气(CPAP)治疗12例,双水平气道正压通气(BiPAP)治疗16例,比较两组治疗前后体征、动脉血气分析的变化、NIPPV时间及最终的插管率和病死率。结果:28例患者总的插管率为17.86%,病死率为7.14%;CPAP组和BiPAP组的插管率、病死率和NIPPV时间均无显著性差异(P均>0.05);NIPPV后2h和24h,两组心率(HR)、呼吸(RR)、氧合指数(PO2/FiO2)均较通气前具有明显改善(P<0.01),而平均动脉压显著降低,仍在可接受范围;NIPPV前、后2h和24h,HR、RR、PO2/FiO2等CPAP组和BiPAP组之间均无显著性差异(P均>0.05)。结论:NIPPV是治疗ACPE的有效和必不可少的一种措施,应早期使用;CPAP和BiPAP两种通气模式对于ACPE具有相同的治疗效果。

Objective： To explore the clinical effects of non-invasive positive pressure ventilation （NIPPV） in patients with acute cardiogenic puhnonary edema （ACPE）. Methods： 28 cases with ACPE treated by NIPPV in Hospital were analyzed retrospectively. 12 cases were treated with continuous positive airway pressure ventilation （CPAP）. 16 cases were treated with hi-level positive airway pressure ventilation （BiPAP）. Clinical signs, blood gas analysis, endotracheal intubation rate, mortality, mean duration of NIPPV after treatment were compared between two groups. Results： Total endotracheal intubation rate and mortality of 28 cases were 17.86% and 7.14% respectively; Endotracheal intubation rate, mortality, means duration of NIPPV were not different significantly between CPAP group and BiPAP group （P〉0. 05）. Heart beat, respiratory rate, and oxygenation index of patients in two groups were improved significantly in hour 2 and hour 24 after NIPPV compared with those in patients before NIPPV in two groups （P〈0.01）. But these parameters between two groups before and after NIPPV were not different significantly （P〉0. 05）. Conclusion： As a valid and essential measure, NIPPV should be enforced in the early stage of ACPE; two modes of NIPPV, CPAP and BiPAP, have the similar effect on ACPE.