经面罩BiPAP无创机械通气与面罩大流量吸氧在治疗急性心源性肺水肿中的应用探讨

Exploration of application of transmask bilevel positive airway pressure noninvasive mechanical ventilation and mask high flow oxygen uptake in treatment of acute cardiogenic pulmonary edema

目的探讨经面罩双水平正压无创机械通气(BiPAP)治疗急性心源性肺水肿(ACPE)的应用价值。方法选择2005年8月～2012年3月收治的经临床确诊为ACPE的患者98例,根据治疗方法不同分为研究组及对照组,每组各49例,均予以抗急性肺水肿等常规药物治疗,对照组同时接受面罩大流量吸氧(MASK),研究组则予以经面罩BiPAP通气治疗,观察两组患者在呼吸频率(RR)、心率(HR)、动脉血酸碱度pH、动脉血气等方面的变化情况以及治疗终点结果的差异性。结果治疗前,两组动脉血气等指标差异无统计学意义(P>0.05)。治疗2h后,两组血氧饱和度(SaO2)[(89.6±6.3)比(85.2±6.6)%]、氧分压(PaO2)[(80.3±8.7)比(68.5±8.9)mm Hg]、HR[(96±28)比(110±27)次/min]、RR[(25±4)比(30±4)次/min]、pH[(7.33±0.05)比(7.30±0.06)]比较差异有统计学意义(P<0.05);治疗结束时,两组患者SaO2[(96.1±3.6)比(87.3±3.2)%]、PaO2[(92.3±8.9)比(87.6±9.1)mmHg]、HR[(80±23)比(92±25)次/min]、RR[(20±2)比(22±2)次/min]、pH[(7.39±0.08)比(7.35±0.07)]比较差异有统计学意义(P<0.05)。研究组患者24 h临床症状、体征缓解率(81.6%比61.2%)高于对照组,住院期肺部感染发生率(3.1%比32.7%)、气管插管率(8.26%比30.6%)及病死率(2.0%比18.4%)均显著低于对照组,差异有统计学意义(P<0.05)。结论 BiPAP机械无创通气治疗ACPE更加地迅速,有效缓解临床症状、体征,改善肺水肿和低氧血症,可作为抢救ACPE患者的首选手段之一。

Objective To investigate the efficacy of the transmask bilevel positive airway pressure noninvasive me chanical ventilation（BiPAP） in the treatment of acute cardiogenic pulmonary edema（ACPE）.Methods 98 patients with ACPE from August 2005 to March 2012 were assigned to research group and control group with 49 patients in each group.All the patients were given conventional medication such as anti-acute pulmonary edema.Meanwhile,the control group were treated with mask high flow oxygen uptake（MASK） and the control group were treated with trans mask BiPAP ventilation treatment.The respiratory rate（RR）,heart rate（HR）,arterial blood pH and arterial blood gas changes as well as the results differences in the end of treatment of the two groups were observed.Results Arterial blood gas indicators before the treatment between the two groups was found had no statistically significant difference（P 0.05）.After 2 hours of treatment,the two groups were significantly different in the arterial oxygen saturation（SaO2） [（89.6±6.3） vs（85.2±6.6）%],oxygen partial pressure PaO2 [（80.3±8.7） vs（68.5±8.9） mm Hg],HR [（96±28） vs（110±27） times/min],RR [（25±4） vs（30±4） times/min],pH [（7.33±0.05） vs（7.30±0.06）]（P 0.05）;At the end of treatment,the two groups were significantly different in the arterial oxygen saturation SaO2 [（96.1±3.6） vs（87.3±3.2）%],PaO2 [（92.3 ±8.9） vs（87.6 ±9.1） mm Hg],HR [（80 ±23） vs（92 ±25） times/min],RR [（20 ±2） vs（22 ±2） time/min],pH [（7.39±0.08） vs（7.35±0.07）]（P 0.05）.The clinical signs and symptoms,remission rate in research group was higher than that in control group（81.6% vs 61.2%）,incidence of pulmonary infection in hospital,endotracheal intubation rate,fatality rate in research group was lower than that in control group（3.1% vs 32.7%）,（8.26% vs 30.6%）,（2% vs 18.4%）,the differences were statistically significant（P 0.05）.Conclusion In the treatment of ACPE,BiPAP mechanical ventilation therapy is faster,alleviates clinical symptoms and signs effectively and improves pulmonary edema and hypoxemia and it is one of the preferred choices of rescuing ACPE patients.