BiPAP鼻罩式机械通气治疗左心衰竭

目的 探讨BiPAP鼻罩式双向正压机械通气治疗左心衰竭的疗效，适合的通气压力等具体方法，了解其对血液动力学的影响。方法 对35例各种病因所致严重左心衰竭患在常规药物治疗基础上采用BiPAP ST-D-20,ST-D-30呼吸机经鼻罩双向正压通气，以流量触发，压力支持，所以给吸气压8－15cm H2O，呼气压2－5cm H2O，氧浓度28－35％，患尽量闭口呼吸，对其中8例患插入Swan-Ganz漂浮热稀释导管，用HPMI166A型心电监护仪及配套血液动力学插件测定及计算各项血液动力学指标。同时与35例常规药物治疗组进行对比。结果 BiPAP组经鼻罩式机械通气后所有患呼吸频率减慢，心率下降，呼吸困难缓解，治疗总有效率为100％，对血压无明显影响，呼吸困难开始缓解时间为10min-3h，对8例BiPAP鼻罩式机械通气患血液动力学监测显示，平均肺动脉压和肺毛细血管楔压下降，心指数无明显变化，心搏指数增加，对照组在相应时间治疗总有效率仅为63．33％，结论 BiPAP鼻罩式双向正压机械通气是治疗左心衰竭的快速有效方法。

Treatment of BiPAP mechanical ventilation by nasal mask on left ventricular failure

Objective　To investigate the role and methods of Bi-level positive airway pressure (BiPAP) mechanical ventilation by nasal mask on left ventricular failure (LVF). Methods　BiPAP group: 35 patients with severe LVF from various causes were treated by nasal BiPAP ST-D-20, ST-D-30 accessory machines with traditional drugs. During the management, the patients inhaled and exhaled with mouth closed. The machines were triggered by flow and maintained with pressure. Both the inspiratory pressure and expiratory pressure were 8－15 cm H2O, 2－5 cm H2O, respectively. The used oxygen density was 28%－35%. The hemodynamic data were measured by (HPMI166A) cardiac electric record insturment and paired hemodynamic software in 8 patients who were inserted with Swan- Ganz floating hot dilated catheter. Control group: 35 patients were treated with traditional drugs alone, and the results were compared with those of BiPAP group. Results　Dyspnea were relieved in all patients in BiPAP group, both the respiratory rate and heart rate were slowed ［from (30.33±8.98)/min to (21.12±3.03)/min, and from (98.21±20.62)/min to (82.11±7.93)/min, respectively］. There were no change in blood pressure. The dyspnea is markly relaxed about ten minutes to three hours after the administration of BiPAP. The effiency rate is 100%, while the total efficiency rate is only 63.33% in control group. The hemodynamic records indicated that mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were decreased ［from (29.96±3.15) mm Hg to (21.40±2.81) mm Hg and from (19.22±1.34) mm Hg to (12.18±1.77) mm Hg, respectively］. Cardiac index (CI) had no change, but stroke index (SI) was increased (from 29.19±3.14 to 34.46±4.48 ). Conclusion　The use of BiPAP mechanical ventilation therapy is feasible and effective on LVF.