呼气末正压通气治疗难治性急性肺水肿的临床研究

Clinical study of positive end-expiratory pressure ventilation in the treatment of severe acute pulmonary edema

对 31例经常规治疗无效的急性肺水肿 (心源性和非心源性 )患者 ,经口或鼻气管插管后给予 PEEP通气治疗 ,PEEP压力一般为 5～ 10 m m H2 O。观察通气前后动脉血气分析中 p H、Pa O2 、Pa CO2 、Sa O2 的变化 ,并观察 HR、RR、MAP及临床症状的变化。结果 :经 PEEP通气治疗后 ,31例患者临床症状均有明显改善 ,动脉血气分析中 p H、Pa O2 、Pa CO2 、Sa O2 治疗前后有显著性差异 (P<0 .0 5 ) ,对 MAP无明显影响 (P>0 .0 5 ) ;2例神经源性肺水肿 (NPE)患者最终死于多脏器功能衰竭 (MOF)。认为应用适当 PEEP通气治疗难治性肺水肿 ,能迅速改善患者症状和低氧血症 。

To evaluate the clinical application of PEEP ventilation in the treatment of severe acute pulmonary edema,31 patients with severe acute pulmonary edema were treated with PEEP ventilation,PEEP pressure 5~10cmH 2O The changes of clinical symptoms,HR RR MAP and arterial blood gas (pH,PaO 2,PaCO 2,SaO 2)were measured to evaluate the efficacy of PEEP ventilation The results showed after PEEP ventilation, the clinical symptoms of all patients has been improved significantly, arterial blood gas (pH,PaO 2,PaCO 2,SaO 2) showed a statistical differences (P<0 05), MAP was not change (P>0 05) But 2 patients of NPE died of MOF These suggest PEEP ventilation could improve symptoms and hypoxemia in patients with severe acute pulmonary edema, it is a effective method in treating severe acute pulmonary edema