不同无创通气模式治疗急性心源性肺水肿的效果比较

A comparative study on the efficacy of different modes of noninvasive ventilation in the treatment of acute cardiogenic pulmonary edema

目的观察双水平正压通气(BiPAP)和持续气道正压通气(CPAP)治疗急性心源性肺水肿(ACPE)的疗效。方法 116例ACPE患者随机分为A组(32例)、B组(42例)和C组(42例),3组在常规处理的基础上,A组采用鼻塞或面罩吸氧,B组采用BiPAP,C组采用CPAP。比较3组的疗效、入院24 h病死率、并发症、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、pH值、血氧饱和度(SpO_2)、动脉血二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)、氧合指数、B型脑钠肽(BNP)和血管外肺水量。结果 B、C组的疗效、SpO_2、PaO_2和氧合指数均明显高于A组(P<0.05),MAP、HR、RR、Pa CO_2、BNP和血管外肺水量明显低于A组(P<0.05)。结论采用CPAP和BiPAP治疗ACPE的疗效更为明确。

Objective To investigate the efficacy of bi-level positive airway pressure（BiPAP）and continuous positive airway pressure（CPAP）in the treatment of acute cardiogenic pulmonary edema（ACPE）.Methods One hundred and sixteen patients with ACPE were randomly divided into Group A（32 cases）,Group B（42 cases）and Group C（42 cases）according to the patient’s condition and will.On the basis of conventional treatment,Group A was treated with nasal or mask oxygen inhalation,Group B was treated with BiPAP and Group C was treated with CPAP.The curative effect,the 24h mortality rate,complications,the mean arterial pressure（MAP）,heart rate（HR）,respiratory rate（RR）,p H,oxygen saturation（SpO2）,arterial partial pressure of carbon dioxide（PaCO2）,arterial oxygen pressure and oxygenation index（PaO2）,B-type natriuretic peptide（BNP）and extravascular lung water of pretherapy were compared among the 3 groups.Results The total effective rate,SpO2 and PaO2 of Group B and Group C were significantly higher than those of Group A（P〈0.05）.After treatment,the MAP,HR,RR,PaCO2,BNP and extravascular lung water volume in Group B and Group C were significantly lower than those in Group A（P〈0.05）.Conclusion The CPAP and BiPAP have a more definite efficacy in the treatment of ACPE.