不同无创通气模式治疗对心源性肺水肿患者低氧血症和血流动力学的影响

The effects of different non-invasive ventilation modes on hypoxemia and hemodynamics in patients with cardiogenic pulmonary edema

目的探讨双水平气道正压(BiPAP)和持续气道正压(CPAP)对急性心源性肺水肿(ACPE)治疗效果和相关指标的影响。方法我院收治的ACPE患者136例,按照随机数字表法分为BiPAP组和CPAP组各68例,比较两组治疗效果、临床相关指标及治疗不耐受情况。结果两组总有效率比较差异无统计学意义(P>0.05);干预后,两组PaO_(2)和PaO_(2)/FiO_(2)均增高,RR降低,BiPAP组PaO_(2)/FiO_(2)高于CPAP组,RR低于CPAP组(P<0.05);两组心率和平均动脉压下降,心输出量上升(P<0.05),但组间比较差异无统计学意义(P>0.05);所有患者未发生心肌梗死,两组治疗无效、腹胀、口鼻咽喉干燥、面部压迫及总不耐受发生率比较差异无统计学意义(P>0.05)。结论相比CPAP,BiPAP在ACPE患者治疗中的有效性和安全性效果相当,并且在改善患者PaO_(2)/FiO_(2)和RR上有一定的优势。

Objective To investigate the curative effect of bi-level positive airway pressure(BiPAP)and continuous positive airway pressure(CPAP)in the treatment of acute cardiogenic pulmonary edema(ACPE),and the influence on related indexes.Methods A total of 136 patients with ACPE admitted to our hospital were selected.According to the random number table method,they were divided into a BiPAP group and a CPAP group,68 in each group.Curative effect,clinical related indexes,and treatment intolerance were compared between the two groups.Results There was no significant difference in the total effective rate between the two groups(P>0.05).After intervention,PaO_(2) and PaO_(2)/FiO_(2) were increased and respiratory rate(RR)was decreased in both groups.PaO_(2)/FiO_(2) was higher and RR was lower in the BiPAP group than those in the CPAP group(P<0.05).Heart rate and mean arterial pressure were decreased,and cardiac output was increased in both groups(P<0.05),but there was no significant difference between the two groups(P>0.05).No myocardial infarction occurred in all patients.There was no significant difference in the incidence of ineffective treatment,abdominal distension,dry mouth,nose and throat,facial compression and total intolerance between the two groups(P>0.05).Conclusion Compared with CPAP,BiPAP has similar efficacy and safety effects in the treatment of ACPE patients,and has certain advantages in improving PaO_(2)/FiO_(2) and RR of patients.