早期比例辅助通气救治急性心源性肺水肿的疗效分析

Clinical study on early application of proportional assist ventilation in the treatment for acute carcinogenic pulmonary edema

目的:评价急救中早期比例辅助通气(PAV)治疗急性心源性肺水肿(ACPE)的临床效果。方法:60例ACPE患者随机分为对照组、PAV组和双水平正压通气(BiPAP)组,每组各20例。对照组给予吸氧、吗啡、利尿剂、血管扩张剂、洋地黄类强心剂和氨茶碱等常规治疗,PAV组和BiPAP组分别给予PAV+常规治疗和BiPAP+常规治疗。比较3组治疗前和治疗后2h各项生理参数、动脉血气、视觉模拟评分(VAS)、气道峰压(PIP)和气管插管率的变化。结果:3组治疗后的各项生理参数均较治疗前改善(P<0.05),与对照组比较,PAV组和BiPAP组的心率、呼吸频率和气管插管率均减低(P<0.05),氧分压和动脉血氧饱和度明显升高(P<0.05),PAV组的VAS评分和PIP低于BiPAP组(P<0.05)。结论:尽早应用PAV和BiPAP均可迅速改善ACPE患者的生理参数和动脉血气指标,缓解呼吸困难;PAV气道峰压较低、同步性和舒适性好,安全、有效,更易为患者接受。

Objective： To explore the effects of early application of proportional assist ventilation（PAV） on patients with acute carcinogenic pulmonary edema （ACPE） in Emergency Department. Method： Sixty patients with ACPE were randomly divided into three groups with 20 patients in each. The patients in control group received routine treatment, including oxygen, morphine diuretics, vasodilators, digitalis and aminophylline. The patients in PAV group and Bilevel positive airway pressure （BiPAP）group were treated respectively with PAV mode of noninvasive mechanical ventilation and BiPAP ventilation in the early stage on the basis of routine treatment. Physiological parameters,arterial blood gas,visual analogue scale（VAS）, peak airway pressure and endotracheal intubation rate at admission and 2 hours after therapy were measured and compared among the three groups. Result：The physiological parameters improved in three groups after treatment. Compared to the control group, heart rate, respiratory rate and endotracheal intubation rate were significantly decreased（P〈0.05）,and the arterial oxygen saturation and the partial pressure of oxygen were significantly improved（P〈0.05）. The peak airway pressure and VAS in PAV group were lower than those in BiPAP group（P〈0.05）. Conclusion.. Early application of PAV and BiPAP ventilation can regulate the physiological parameter and arterial blood gas, and alleviate the symptom of dyspnea. Synchronization and comfort in PAV group were better than those in BiPAP group. The PAV ventilation is proved to be valuable,safety and well accepted by patients with ACPE.