两种无创正压通气模式治疗急性心源性肺水肿的临床观察

The Clinical Observation of Patients with Acute Cardiogenic Pulmonary Edema treated by Noninvasive Positive Pressure Ventilation

目的:探讨无创机械通气双水平正压通气(BiPAP)模式与持续正气道压通气(CPAP)模式治疗急性心源性肺水肿(ACPE)的临床疗效。方法:65例ACPE患者在应用常规吸氧及药物治疗基础上随机分为BiPAP组(n=33)和CPAP组(n=32),分别联用无创呼吸机进行BiPAP和CPAP模式治疗,比较两组临床症状和体征、动脉血气分析及N末端利钠肽前体(NT-proBNP)等。结果:两组患者治疗后临床症状、体征明显改善,呼吸频率、心率、平均动脉压及NT-proBNP均较治疗前显著降低(P<0.01),PaO_2、SaO_2较治疗前显著增高(P<0.01),BiPAP组(n=33)的总有效率100.0%与CPAP组(n=32)的96.88%无显著性差异(P>0.05)。结论:无创机械通气BiPAP和CPAP治疗ACPE均疗效显著。

Objective： To explore the clinical efficacy of patients with acute cardiogenic pulmonary edema （ACPE） treated by modes of bi-level positive airway pressure （BiPAP） and continuous positive airway pressure （CPAP） of noninvasive positive pressure ventilation. Methods： 65 patients with ACPE were divided into BiPAP group （n=33）received BiPAP ventilation and CPAP group （n=32）received CPAP ventilation besides conventional therapy. The clinical symptoms and signs, artery blood gases and N-terminal pre-brain natriuretic peptide （NT-proBNP） were compared between the two groups. Results： In both groups , the clinical symptoms and signs improved significantly, heart rate, respiratory rate,mean arterial pressure and PaCO2 significantly decreased after treatments （P 〈 0.05）, PaO2 and SaO2 increased obviously（P 〈 0.01）,the NT-proBNP level decreased （P 〈 0.01）. The total efficacy rates were no statistical difference between the two groups（100.0% ＆ 96.88% ,P 〉 0.05）. Conclusion： Both BiPAP and CPAP of noninvasive positive pressure ventilations are effective in the treatment of patients with ACPE.