无创双水平正压通气纠正急性心源性肺水肿缺氧在综合救治中的价值

The value of improving hypoxemia by non - invasive bilevel positive airway pressure ventilation （NIBiPAP） for patients with acute cardiogenic pulmonary edema （ACPE） on comprehensive management

目的评价无创双水平正压通气（NIBiPAP）纠正急性心源性肺水肿（ACPE）缺氧在综合救治中的价值。方法对所有于2010—06—2012—05收入急诊病房的ACPE患者给予常规传统治疗（强心、利尿、扩血管、给氧），30min内缓解不明显而接受NIBiPAP作为研究组，患者或家属拒绝接受NIBiPAP作为对照组；依据1h、3h内临床症状与体征缓解程度、各项监测指标改善判断临床疗效，分别为显著有效（显效）、有效、无效，总有效率为显效与有效数占各组总数的百分率，并分别统计两组患者入院24h病死率。结果研究组与对照组各25例，两组患者一般情况差异无统计学意义（P〉0．05），研究组治疗后1h、3h各项监测指标（pH、PaO2、PaCO2、SaO2、HR、RR、SBP、DBP）自身比较、与对照组比较均改善明显（P〈0．05），3h后临床综合评价总有效率（96．O％）显著高于对照组（72．0％），差异有统计学意义（P〈0．05）；研究组病死率（0）低于对照组（12％），但差异无统计学意义（P〉0．05）。结论NIBiPAP在ACPE综合救治中较常规氧疗更能有效地纠正缺氧。

Objective To explore the value of improved hypoxemia by non - invasive bilevel positive airway pressure ventilation （ NIBiPAP ） for patients with acute cardiogenie pulmonary edema （ACPE） on their comprehensive management. Methods All patients with ACPE managed in emergency department during the period from 1 June 2010 to 31 May 2012 were collected and treated prospectively by conventional treatment （cardiotonic, diuretics, nitrates to vasodilatation） versus oxygen therapy first. About 30 rain later, patients whose conditions had not been improved by above management were divided into two research and control groups according to received NIBiPAP or not. Patients met in control group did not receive NIBiPAP due to themselves or their relatives refused. All of their symptoms and vital signs were monitored continuously and parameters of artery blood gas analysis （ pH, PaO2 , PaC02, SaO2 ） were taken before, 1 and 3 hours treatment later. The clinical effects were evaluated based on above. The rates of significantly effective, effective and ineffective were made. The total effective rate（ significant effective rate plus effective rate） and mortality of 24 h hospital admission were calculated and compared between two groups. Results For 25 cases of two groups respectively there were no significant difference （ P 〉 0.05 ） on their general condition （ gender, age and APACHE Ⅱ scores）. One and 3 hours treatment later the symptoms, vital signs and various parameters of artery blood gas analysis of patients in research group were improved more significant than themselves before and patients in control group（P 〈 0.05）. Their total effective rate （96%） was higher significantly than control group（72.0% ） （P 〈 0.05）, there were no patients dead during the first 24 h in research group was much lower than in control group （16%） and mortality rate 0 in research group and mortality was lower than control group （ 12% ）. But No significant differences was found between two groups （ P 〉 0.05 ）. Conclusion The major benefit of NIBiPAP on comprehensive management for patients with ACPE was their hypoxemia can be improved more rapidly and effectively than conventional oxygen therapy.