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目的:探讨有创-无创序贯机械通气对急性心源性肺水肿患者低氧血症及血流动力学的影响。方法:按照随机数字表法将2013年3月至2015年3月我院收治的49例急性心源性肺水肿患者分为两组,对照组行常规抗心衰治疗联合有创机械通气,观察组接受对照组治疗方案后,再给予无创鼻面罩双水平气道正压通气。比较两组患者治疗前后的动脉血气分析指标及血流动力学指标,以及有创机械通气时间、机械通气总时间、呼吸机相关肺炎(VAP)发生率、再发心衰率及死亡例数。结果:两组患者治疗过程中未出现死亡病例,治疗后,两组患者动脉血气分析指标、血流动力学指标较治疗前不同程度的改善,差异有统计学意义(P<0.05),两组患者治疗后的动脉血气分析指标、血流动力学指标比较,差异无统计学意义(P>0.05)。观察组患者有创通气时间、通气总时间少于对照组,VAP发生率低于对照组,差异有统计学意义(P<0.05),两组患者再发心衰率差异无统计学意义(P>0.05)。结论:有创-无创序贯机械通气能有效改善急性心源性肺水肿患者的低氧血症和血流动力学指标,安全有效,作为抢救急性心源性肺水肿的措施具有重要临床价值。
Objective: To investigate the effects of invasive-noninvasive sequential mechanical ventilation on hypoxemia and hemodynamics in patients with acute cardiogenic pulmonary edema. Methods: According to the random number table method, 49 cases of acute cardiogenic pulmonary edema admitted to our hospital from March 2013 to March 2015 were divided into two groups. The control group received conventional anti-heart failure combined with invasive mechanical ventilation. Group accepted the control group after treatment, and then given non-invasive nasal mask double horizontal positive airway pressure. Arterial blood gas analysis and hemodynamic indexes before and after treatment were compared between the two groups. The duration of invasive mechanical ventilation, total duration of mechanical ventilation, incidence of ventilator-associated pneumonia (VAP), recurrent heart failure rate and number of deaths were compared. Results: No deaths occurred in the two groups. After treatment, arterial blood gas analysis and hemodynamics indexes of both groups were improved to some extent compared with those before treatment, with significant difference (P <0.05). Two groups Arterial blood gas analysis of patients after treatment indicators, hemodynamic indicators, the difference was not statistically significant (P> 0.05). The duration of invasive ventilation in the observation group was shorter than that in the control group, and the incidence of VAP was lower than that in the control group (P <0.05). There was no significant difference between the two groups in recurrence of heart failure (P > 0.05). CONCLUSION: The invasive and noninvasive sequential mechanical ventilation can effectively improve the hypoxemia and hemodynamics in patients with acute cardiogenic pulmonary edema, which is safe and effective and has important clinical value as a measure to rescue acute cardiogenic pulmonary edema.