有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的对比研究

Comparative study of the treatment in acute cardiogenic pulmonary edema between the noninvasive positive pressure ventilation by invasive ventilator and the conventional oxygen therapy

目的评价有创呼吸机实施无创正压通气（NPPV）在急性心源性肺水肿治疗中的作用。方法82例急性心源性肺水肿患者随机分为NPPV组43例，常规吸氧组39例。除常规治疗外，前者使用有创呼吸机给予NPPV，后者给予常规氧疗，以2h抢救成功率、2h抢救总有效率、气管插管率、抢救室停留时间和幸存出院率评价治疗效果，观察比较副反应和并发症发生率。结果2h抢救成功率：NPPV组60．47％（26例），常规吸氧组17．95％（7例），两组比较差异有统计学意义（P〈0．01）；2h治疗总有效率（2h抢救成功率＋2h抢救有效率）：NIPPV组97．67％（42例），常规吸氧组89．74％（35例），两组比较差异无统计学意义（P=0．19）；气管插管率：NPPV组2．33％（1例），常规吸氧组15．38％（6例），两组比较差异有统计学意义（P=0．035）；抢救室停留时间：NPPV组（2．61±0．23）h，常规吸氧组（5．36±0．58）h，两组比较差异有统计学意义（P〈0．01）；幸存出院率：NPPV组97．67％（42例），常规吸氧组89．74％（35例），两组比较差异无统计学意义（P=0．068）；副反应发生率：NPPV组11．63％（5例），常规吸氧组5．13％（2例），两组比较差异无统计学意义（P=0．293）。结论正确使用有创呼吸机实施NPPV能提高急性心源性肺水肿急诊抢救成功率，降低气管插管率，缩短抢救室停留时间，在缺乏无创呼吸机的情况下可以作为急性心源性肺水肿的辅助治疗手段。

Objective To evaluate the effects of noninvasive positive pressure ventilation （NPPV） on acute eardiogenic pulmonary edema by invasive ventilator. Methods 82 patients with acute cardiogenic pulmonary edema were divided into two groups： 43 patients were randomized to receive NPPV by invasive ventilator based on conventional therapy as NPPV group; 39 patients were randomized to receive conventional oxygen therapy based on conventional therapy as conventional oxygen therapy group. We evaluate the treatment effects by measuring the success rate of 2 h rescue and the general treatment efficiency of 2 h （ the success rate of 2 h rescue and the treatment efficiency of 2 h ）, the intubation rate, the residence time in emergency room and the rate of discharging from hospital, and by observing and comparing the complications and the side - effects. Results Success rate of 2 h rescue ： NPPV group was 60.47% （26 of 43） ,conventional oxygen therapy group was 17.95% （7 of 39, P 〈 0. 01 ） ;the general treatment efficiency of 2 h： NPPV group was 97.6% （42 of 43 ）, conventional oxygen therapy group was 89.74% （ 35 of 39, P = 0.19 ） ; intubation rate ： NPPV group was 2.33% （ 1 of 43 ） ,conventional oxygen therapy group was 15.38% （6 of 39 ,P = 0. 035 ） ; residence time in emergency room：NPPV group was （2.61±0.23） h,conventional oxygen therapy group was （5.36±0.58） h,P 〈 0.01 ;the rate of discharging from hospital： NPPV group was 97.67% （42 of 43 ） , conventional oxygen therapy group was 89.74% （35 of 39,P =0. 068） ;side - effect rate：NPPV group was 11.63% （5 of 43 ） ,conventional oxygen therapy group ,sas 5.13% （2 of 39 ,P =0. 293）. Conclusion The therapy of noninvasive positive pressure ventilation could increase the successful treatment rate of acute cardiogenic pulmonary edema by correctly using invasive ventilator, reducing intubation rate, shortening the residence time in emergency room, and could be used as adjunctive treatment of acute cardiogenic pulmonary edema in the case of the lack of noninvasive ventilator.