不同无创正压通气模式治疗急性心源性肺水肿的疗效观察

Clinical effect of different models of noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema

目的对比分析持续气道正压通气(CPAP)和双水平气道正压通气(BiPAP)治疗急性心源性肺水肿(ACPE)的疗效。方法选择2009年1月至2013年5月宜兴市人民医院收治的68例ACPE患者作为研究对象,所有患者经常规治疗30 min无显效后抽签随机分为对照组(22例)、CPAP组(31例)和BiPAP组(15例)。对照组继续给予常规处理,CPAP组在常规治疗基础上辅助CPAP通气,BiPAP组则辅助BiPAP通气。对比观察三组患者治疗60 min后的疗效、血气分析及生命体征变化及两种无创正压通气模式患者舒适度和不良反应。结果治疗60 min后,CPAP组和BiPAP组有效率分别为83.87%和86.67%,高于对照组的59.09%,χ2检验显示三组间有效率差异无统计学意义(P=0.064),但趋势χ2检验显示,有效率由对照组向BiPAP组显著提高(P=0.038);血气分析及生命体征等相关指标与治疗前比较三组均显著改善(P均<0.05),治疗后CPAP组和BiPAP组间比较差异无统计学意义(P均>0.05);BiPAP组患者舒适度显著优于CPAP组(P<0.05),两组不良反应均较少,差异无统计学意义(P>0.05)。结论 CPAP与BiPAP通气对ACPE患者疗效安全、确切,BiPAP通气的患者舒适度较CPAP通气模式高,但操作难度大且需要专人看护,临床应根据患者实际情况选择合适的治疗方法。

Objective To compare the clinical effects of continuous positive airway pressure （CPAP） and Bi-level positive airway preasure ventilation （BiPAP） in the treatment of acute cardiogenic pulmonary edema （ACPE）. Methods A total of 68 pateints in Yixing People Hospital from January 2009 to May 2013 were enrolled in this study. All patients showed no improvement after 30 min of conventional therapy, which were then randomly divided into three groups with draw lots： the control group （n=22）, CPAP group （n=31） and BiPAP group （n=15）. The control group received conventional therapy eontinuely, while the CPAP group and BiPAP group received additional ventila- tion with CPAP and BiPAP, respectively. The curative effect, blood gas analysis and vital signs changes of the three groups were analyzed after treatment for 60 rnin. The patients＇ comfort degree and adverse effects under two modes of mechanical ventilation were also observed. Results The effective rates of CPAP group and BiPAP group after 60 min of treatment were 84.38% and 86.67%, respectively, which were higher than that of the control group （59.09%）. The chi-square test demonstrated that there was no significant difference in the effective rates between the three groups （P=-0.064）. However, the trend of test showed that the effective rate had a incresing trend from the control group to Bi-PAP group （P-~.038）. ARer treatment, the indexes of blood gas analysis and vital signs were improved significantly in the three groups （all P〈0.05）, with no significant difference between CPAP group and BiPAP group （all P〉0.05）. The comfort degree of patients in BiPAP group was higher than that of CPAP group （P〈0.05）, whereas adverse effects of the both two groups were low, with no statistical significant difference （P〉0.05）. Conclusion Both modes of nonin- vasive mechanical ventilations were safe and effective for treating ACPE. The comfort degree of patients in BiPAP is higher than that of CPAP. However, the operation of BiPAP is more difficult and the patients need special care. The models should be selected reasonably according to the actual situation of patients in clinic.