两种无创通气模式治疗妊娠合并急性心源性肺水肿的临床观察

Clinical observation of two models of noninvasive ventilation and oxygen in treatment of pregnant women with acute cardiogenic pulmonary edema

目的评价两种无创通气(noninvasive pressure,NIV)模式治疗妊娠期合并急性心源性肺水肿(acute cardiogenic pulmonary edema,ACPE)的临床效果和耐受性。方法妊娠合并ACPE 57例在常规药物治疗的基础上,随机分持续正压通气(continuous positive airway pressure,CPAP)组、双水平正压通气(bi-level positive airway pressure,BiPAP)组和常规给氧组(对照组),观察分析三组治疗2 h后生理参数、动脉血气变化、气管插管率、死亡率和住院天数以及胎儿Apgar评分等指标。结果 CPAP组和Bi-PAP组治疗后心率、呼吸频率、pH值、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉氧饱和度(SaO2)与对照组比较差异均有统计学意义(P<0.01)。常规给氧组气管插管率为17.6%,CPAP组和BiPAP组均为5.0%(P<0.05)。胎儿出生后1 min的Apgar评分,CPAP组和BiPAP组较对照组显著改善(P<0.05),CPAP组和BiPAP组之间无差异(P>0.05)。三组住院期间死亡率、住院时间差异无统计学意义(P>0.05)。结论 CPAP和BiPAP均可改善妊娠合并ACPE患者生理参数、动脉血气指标,降低气管插管率,增加出生胎儿Apgar评分。两无创通气模式治疗妊娠期患者均有良好的耐受性。

Objective To investigate the clinical efficacy and tolerance of noninvasive ventilation in pregnant patients with ACPE. Methods 57 pregnant patients with ACPE were randomly divided into 3 groups on the basis of traditional medical therapy： CPAP group, BiPAP group and oxygen group. The changes of arterial blood gases and vital signs were analyzed after 2 hours. The incidences of endotracheal intubation, mortality and days of admission were recorded. The Apgar scores were measured after birth. Results Treatments with CPAP or BiPAP resulted in significant improvement in the respiratory and heart rates, pH, PaO2, PaCO2, SaO2, and Ap- gar scores compared with oxygen therapy （P 〈 0.05）. The incidence of endotracheal intubation was 17.6% in the oxygen group, and it was 5.0% in each noninvasive ventilation group （ P 〈 O. 05 ）. Mortality up to hospital discharge and days of admission were not different statistically among groups （P 〉 0.05）. Conclusion Com- pared with oxygen therapy, the treatment with CPAP or BiPAP in pregnant patients with ACPE resulted in simi- lar improvement in vital signs,blood gases and a lower rate of endotracheal intubation. No severe complications were associated with either of the noninvasive ventilation strategies.