无创呼吸机辅助治疗急性广泛前壁心肌梗死所致急性心源性肺水肿的作用

Assistant effect of non-invasive ventilator in patients with acute cardiogenic pulmonary edema induced by acute myocardial infarction in extensive anterior wall

目的评价无创正压通气在急性广泛前壁心肌梗死致急性心源性肺水肿抢救辅助治疗中的临床价值。方法对38例急性广泛前壁心肌梗死致急性心源性肺水肿患者在常规治疗下不能有效改善低氧血症时,使用双水平正压通气(BiPAP)治疗。观察治疗前后患者临床症状及体征、动脉血pH、氧分压、二氧化碳分压、心率、呼吸频率、平均动脉压、血氧饱和度、胸片结果、心脏超声心动图结果、血清N端脑钠肽浓度的变化。结果 36例患者在无创机械通气后呼吸困难明显减轻,症状和体征也明显改善,治疗总有效率94.7%(36/38)。治疗后2 h、4 h、24 h动脉血pH、氧分压、二氧化碳分压、心率、呼吸频率、平均动脉压及血氧饱和度较治疗前明显改善(P<0.05);血清N端脑钠肽浓度较治疗前明显下降(P<0.05);心脏超声心动图示左心室射血分数较治疗前明显升高(P<0.05)。胸片提示肺水肿明显吸收。结论无创双水平正压通气可明显改善急性广泛前壁心肌梗死致急性左心衰竭患者低氧血症,提高急性广泛前壁心肌梗死抢救成功率,改善心功能。

Objectives To evaluate the clinical effect of using non-invasive positive pressure ventilation for cases with acute cardiogenic pulmonary edema caused by acute myocardial infarction in extensive anterior wall.Methods Thirty-eight patients with acute left heart failure caused by acute myocardial infarction in extensive anterior wall,whose hypoxemia could not be improved under routine treatment,were treated by using bi-level positive airway pressure（Bi-PAP）.We analyzed the clinical symptoms and physical signs,artery blood pH,partial pressure of oxygen in artery（PaO2）,partial pressure of carbon dioxide in artery（PaCO2）,heart rate（HR）,respiration rate（RR）,mean arterial blood pressure（MAP）and arterial oxygen saturation（SaO2）of blood gas analysis,chest X-ray,echocardiography and serum concentration of N-terminal-Pro-B-type natriuretic peptide（NT-proBNP） before and after treatment.Results The dyspnea of 36 cases were obviously relieved by using non-invasive ventilator.The artery pH,PaO2,PaCO2,HR,RR,MAP and SaO2 of blood gas analysis at 2 h,4 h,24 h after treatment were also improved（P 0.05）,as well as the clinical symptom and physical signs;the value of left ventricular ejection fraction was significantly higher than those before treatment（P 0.05）,and the serum concentrations of NT-proBNP was significantly decreased compared with those before treatment（P 0.05）.X-ray result showed that pulmonary edema was absorbed.The total effective rate was 94.7%（36/38）.Conclusions Non-invasive Bi-PAP can improve the hypoxemia and cardiac function in patients with acute left heart failure caused by acute myocardial infarction in extensive anterior wall,and also increase the successful rescue rate.