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目的探讨无创正压通气(noninvasive positive pressure ventilation,NIPPV)对急性中毒性肺水肿的临床效果。方法选择符合中毒性肺水肿诊断并且氧合指数(oxygenation index,PaO2/FiO2,OI)低于300mmHg的患者48例,随机分成无创正压通气组(NIPPV组)25例及常规治疗组23例;NIPPV组在常规治疗的基础上给予以经面罩接呼吸机辅助通气(通气模式ASB+PEEP)。结果治疗1h后,NIPPV组的血气分析结果、氧合指数、呼吸频率(respiratory rate,RR)、氧饱和度(blood oxygen saturation,SaO2)均较治疗前显著改善(P<0.01)。与常规治疗组比较,OI、SaO2明显占优(P<0.01),总住院费用及住院天数也明显少于常规治疗组(P<0.001);同时,NIPPV组的气管插管机械通气率显著低于常规治疗组(P<0.01)。结论急性中毒性肺水肿早期应用无创压力支持通气能迅速改善患者的氧合能力,提高组织氧供,减少并发症,这对提高抢救成功率,改善患者预后有积极作用。
Objective To investigate the clinical effect of noninvasive positive pressure ventilation (NIPPV) on acute toxic pulmonary edema. Methods Forty - eight patients diagnosed as having toxic pulmonary edema with oxygenation index (PaO2 / FiO2, OI) less than 300 mmHg were randomly divided into NIPPV group (n = 25) and conventional treatment group (n = 23) The NIPPV group was given mask-assisted ventilator assisted ventilation (ventilation mode ASB + PEEP) on a routine basis. Results After 1 hour of treatment, the blood gas analysis results, oxygenation index, respiratory rate (RR) and blood oxygen saturation (SaO2) in NIPPV group were significantly improved compared with before treatment (P <0.01). Compared with the conventional treatment group, OI and SaO2 were significantly superior (P <0.01), and the total hospitalization and hospitalization days were significantly less than those in the conventional treatment group (P <0.001). In addition, the mechanical ventilation rate of intubation was significantly lower in the NIPPV group In the conventional treatment group (P <0.01). Conclusion The application of noninvasive pressure-assisted ventilation in early stage of acute toxic pulmonary edema can rapidly improve the oxygenation ability of patients and improve the tissue oxygen supply and reduce the complications, which has a positive effect on improving the rescue success rate and improving the prognosis of patients.