有创—无创序贯机械通气在急性心源性肺水肿的临床疗效观察

Clinical study of sequential invasive-noninvasive mechanical ventilation in acute cardiogenic pulmonary edema patients

目的研究有创—无创序贯机械通气在急性心源性肺水肿中的疗效。方法 32例急性心源性肺水肿患者在常规治疗的基础上,采用有创—无创序贯机械通气治疗,即短期有创呼吸机辅助通气后,继续给予无创鼻面罩双水平气道正压通气,期间调整无创呼吸机以达到脉搏氧饱和度(SPO2)≥92%并最终达到撤机的目的。治疗期间监测患者治疗后的临床征象、动脉血气分析指标的变化、有创机械通气时间、住院期间、并发症的情况,以及患者治疗后无创血流动力学指标心排血量(CO)、心脏指数(CI)、每搏量(SV)的变化。结果给予有创—无创序贯通气治疗后,患者总机械通气时间、呼吸机相关性肺炎发生率降低P<0.05);动脉血气分析指标中PaO2、SaO2明显改善(P<0.05),pH值及PaCO2变化不明显,血流动力学指标CO、CI、SV显著升高(P<0.05);在上述两组患者成功脱机后各项指标比较无统计学差异。结论有创—无创序贯机械通气对急性心源性肺水肿患者有较好的疗效,能明显改善低氧血症和血流动力学指标,可以减少有创机械通气的并发症,是抢救急性心源性肺水肿的一种安全有效的方法。

Objective To study the application in acute cardiogenic pulmonary edema patients during sequential invasive-noninvasive mechanical ventilation. Methods Based on conventional treatment, 36 acute cardiogenie pulmonary edema patients were given sequential invasive and noninvasive mechanical ventilation, the short-term invasive mechanical ventilation, and were continued to provide non-invasive nasal mask bi-level positive airway pressure ventilation in order to achieve the purpose of weaning. During treatments we monitored the patients＇ clinical signs, arterial blood gas analysis indicators changes, invasive mechanical ventilation time, complications, and non-invasive treatment in patients and hemody- namic cardiac output （CO） , cardiac index （CI） , stroke volume （SV） changes. Results Given a sequential invasive-noninvasive ventilation sequential treatment, the total duration of mechanical ventilation and ventilator-associated pneumonia were significantly lower （ P 〈 0.05 ）. Arterial blood gas analysis of indicators in PaO2 , SaO2 was significantly improved （ P 〈 0.05 ） , pH value and PaCO2 did not change significantly, hemodynamics in CO, CI, SV was significantly higher （ P 〈 0.05 ）. In the two groups after successful weaning, there were no significant changes in the indicators. Conlusions Sequential invasive and noninvasive mechanical ventilation in acute cardiogenic pulmonary edema patients with good effects, could significantly improve hypoxemia and hemodynamic parameters, and reduce the complications of invasive mechanical ventilation, and resuce acute heart pulmonary edema in a safe and effective method.