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目的:研究和探讨应用无创机械通气(NIPPV)治疗急性心源性肺水肿(ACPE)的临床价值。方法:将2005年2月-2006年10月我院急诊科救治的54例ACPE患者随机分为常规治疗组和NIPPV组。NIPPV组在给予常规药物治疗基础上,给予压力支持通气(PSV)加呼气末正压(PEEP)通气模式,PSV8～15cmH2O,PEEP5～8cmH2O,常规治疗组给予Venturi面罩吸氧。在治疗第1、2、24h分别测量血气、血压、心率、呼吸频率及无创心功能等临床指标。将2组数据进行对比。结果:与对照组比较,NIPPV组治疗1、2、24h后,患者临床症状与体征改善明显、迅速,其PaO2、氧合指数显著升高,HR、RR及MAP显著下降(组间及组内治疗前后比较P<0.05或P<0.01),心功能明显改善,气管插管率及住院时间显著降低。NIPPV组28例患者有2例改行气管插管(7.14%),对照组有6例改行气管插管(23.07%)(P<0.05)。结论:与常规治疗相比,应用NIPPV治疗ACPE能快速改善氧合、动脉血二氧化碳分压及呼吸困难,减少气管插管,值得在临床推广使用。
Objective: To investigate and explore the clinical value of noninvasive mechanical ventilation (NIPPV) in the treatment of acute cardiogenic pulmonary edema (ACPE). Methods: From February 2005 to October 2006, 54 cases of ACPE treated in our emergency department were randomly divided into routine treatment group and NIPPV group. The patients in NIPPV group were given PSV and PEEP ventilation mode on PSV8 ~ 15cmH2O and PEEP5 ~ 8cmH2O, and the conventional treatment group was given Venturi mask oxygen. Blood pressure, blood pressure, heart rate, respiration rate and noninvasive cardiac function were measured at the first, second and second hour respectively. Compare two sets of data. Results: After treatment for 1, 2 and 24 hours, the clinical symptoms and signs of NIPPV group were improved obviously and quickly. PaO2, oxygenation index and HR, RR and MAP were significantly decreased P <0.05 or P <0.01 before and after treatment), cardiac function improved significantly, intubation rate and hospital stay significantly reduced. Two of the 28 patients in the NIPPV group switched to tracheal intubation (7.14%) and 6 in the control group (23.07%) (P <0.05). CONCLUSION: Compared with conventional treatment, the application of NIPPV in the treatment of ACPE can rapidly improve oxygenation, arterial partial pressure of carbon dioxide and dyspnea, reduce endotracheal intubation, and is worth popularizing in clinic.