机械通气在抢救急性左心衰并呼吸衰竭中疗效分析

目的 探讨机械通气在抢救急性左心衰并呼吸衰竭时的方法和临床疗效.方法 对40例急性左心衰并发呼吸衰竭患者进行机械通气,分析该治疗前后患者血压、心率、呼吸频率、动脉血气(PH、PaO2、SaCO2、PaCO2、HCO3)及X线胸片的变化,总结机械通气治疗急性左心衰的方法和效果.结果 急性左心衰并发呼吸衰竭机械通气之后1h、12h较通气之前的平均血压有所下降(分别为125.0/76.0、115.0/70.5、131.0/78.5mm Hg,1mm Hg=0.133kPa);通气后12h与通气前比较,P＜0.05;平均心率减慢(分别为98、85、110次/min),通气后12h与通气前比较,P＜0.01;平均呼吸频率减慢(分别为22.0、21.0、26.5次/min,均P＜0.05);SaO2显著改善(分别为93.0%、95.5%、82.0%,均P＜0.01);平均PaO2明显增高(从48.9mm Hg增加至90.1mm Hg,P＜0.01),其他动脉血气分析指标无明显变化;治疗前后X线胸片提示肺水肿明显改善.结论 正压机械通气可作为治疗各种原因(包括冠心病急性心肌梗死)引起的急性左心衰并呼吸衰竭的重要辅助措施.

Clinical Value of Mechanical Ventilation in Treatment of Acute Cardiogenic Pulmonary Edema

Objective To investigate the curative effects and methods of mechanical ventilation in treatment of acute cardiogenic pulmonary edema. Methods Clinical features of 40 patients with acute cardiogenic pulmonary edema treated by mechanical ventilation were gathered.Blood pressure,heart rate,respiratory rate,arterial blood gas values and chest X-ray changes before and after ventilation were compared with each other.Results The mean blood pressure after ventilation at 12 hours decreased compared with that before ventilation from 131.0/78.5 to 125.0/76.0 and 115.0/70.5mm Hg(1mm Hg=0.133kPa)(P<0.05).The mean heart rate decreased from 110 to 85 hearts per minute (P<0.01).Either the mean respiratory rate after ventilation at 1 hour or 12 hours decreased compared with before ventilation (22.0,21.0,26.5 beats per minute respectively,P<0.05).The most important is that SaO2 increased from 82% to 93.0% or 95.5% 1 hour or 12 hours after ventilation (P<0.01).The PaO2 increased from 48.9 to 90.1mm Hg after ventilation (P<0.01).However,there were no obvious changes in other arterial blood gas values.The manifestation of pulmonary edema on chest X-ray was improved distinctively after mechanical ventilation.Conclusion Positive pressure ventilation can be considered as an important nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema.