机械通气在抢救急性肺水肿时的临床疗效

目的:探讨机械通气在抢救急性肺水肿时的方法和临床疗效。方法:通过分析我院20例急性肺水肿患者机械通气前后体征(血压、心率、呼吸频率)、血气分析(pH、PaO2、SaO2、PaCO2、HCO3-)、X线胸片的变化,并参考相关文献总结机械通气治疗急性肺水肿的方法和效果。有效的机械通气方法包括:高频通气和呼气末正压通气(PEEP)。结果:急性肺水肿并发呼吸衰竭患者机械通气之后1、12h较通气之前的平均血压有所下降,分别为123.0/74.0、118.0/67.0、129.0/75.5mmHg(1mmHg=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、89、105次/min,通气后12h与通气前比较,P<0.05),平均呼吸频率减慢(分别为22.0、21.0、27.4次/min,均P<0.05),平均SaO2显著改善(分别为91.2%、95.1%、76.2%,均P<0.01)。患者机械通气之后较通气之前PaO2明显增高(从48.8mmHg增加至85.1mmHg),具有统计学意义(P<0.05),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:正压机械通气是治疗各种原因(包括冠心病急性心肌梗死)引起急性严重左心功能不全的重要辅助措施,严格掌握适应证、密切观察病情、选择合适的通气方法、设置合适的参数,可在短期内使急性肺水肿患者病情改善。

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. Method:Clinical features of twenty patients with acute cardiogenic pulmonary edema treated by mechanical ventilation were gathered. Systemic arterial pressure, heart rate and respiratory rate, arterial blood gas values and pH, chest X-ray changes before and after ventilation were compared with each other. Efficacious methods of mechanical ventilation include: high-frequency jet ventilation and positive-end expiratory pressure ventilation (PEEP). Result:After ventilation, the mean blood pressure at 1 hour or 12 hours decreased from 129/75.5 to 123/74 or 118/67 mm Hg respectively. The mean heart rate also decreased from 105 to 98 or 89 beats per minute (P< 0.05), and respiratory rate from 27.4 to 22 or 21 breaths per minute (P< 0.05). The most important is that SaO_2 increased from 76.23% to 91.2% or 95.1% 1 hour or 12 hours after ventilation (P< 0.01). The PaO_2 increased from 48.8 to 85.1 mm Hg after ventilation (P< 0.05). However, there were no obviously 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 is considered as an effective nonpharmacologic method of treating patients with severe acute cardiogenic pulmonary edema. The physiological benefits include improved gas exchange, decreased work of breathing, unloaded circulation stress, and improved lung compliance. Proper patient selection, close patient monitoring, proper application of the technology may result in more rapid improvement of clinical findings and of blood gases as well.