无创机械通气应用于急性心源性肺水肿的临床研究

Non-invasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema

目的探讨无创机械通气(NMV)治疗急性心源性肺水肿(ACPE)的临床应用价值。方法对80例各种原因所致的急性肺水肿患者随机分为NMV治疗组39例和对照组41例,对照组常规药物治疗加鼻导管高流量吸氧,NMV治疗组在常规药物治疗的基础上给予压力支持通气(PSV)加呼吸末正压(PEEP)通气模式,分别监测治疗前及治疗后的临床表现、动脉血气分析、血氧饱和度、呼吸频率、心率、血压等变化。结果治疗组治疗后,39例患者均于30min内症状缓解,除3例较重患者需辅助通气2h才能撤机外,其他均于1h内撤机。撤机后能平卧呼吸,面色恢复正常、大汗消失、口唇无青紫、泡沫样痰消失、双肺啰音明显减少甚至消失阶榱俅哺飨钪副瓯冉喜钜炀哂型臣蒲б庖澹?P<0.05)。结论在常规强心、利尿、扩管等基础治疗同时,加用无创双水平正压机械通气治疗急性肺水肿,可迅速纠正缺氧、改善病情、提高抢救成功率,减少气管插管及气管切开率,降低死亡率。

Objective To investigate the non-invasive mechanical ventilation（NMV） treatment of acute cardiogenic pulmonary edema（ACPE） for clinical application.Methods 80 patients with different causes of acute pulmonary edema were randomly divided into NMV treatment group and control group 39 cases,41 cases of conventional therapy control group,high-flow oxygen by nasal catheter,NMV in the conventional treatment group,drug treatment basis for pressure support ventilation（PSV） plus PEEP（PEEP） ventilation mode,were monitored before treatment and after treatment of clinical manifestations,blood gas analysis,oxygen saturation,respiratory rate,heart rate,blood pressure changes.Results After treatment,39 patients were in remission with in 30 min,in addition to three cases of heavy patients can be assisted ventilation weaning 2 h,the other were at weaning within 1 h.Supine position after weaning can breathe,looking back to normal,sweating away,no purple lips,bubble-like sputum disappeared,bilateral pulmonary rales,decreased or even disappeared.Clinical difference between the two groups of indicators were statistically significant（P0.05）.Conclusion In routine cardiac,diuretic,while expanding treatment and other infrastructure management,plus non-invasive bilevel positive pressare ventilation treatment of acute pulmonary edema,hypoxia can be corrected quickly,to improve the condition,improve the success rate,reduce and traeheal intubation cut rates and reduce mortality.