不同通气参数在双水平无创正压通气治疗急性左心衰竭患者时疗效的比较

目的:比较双水平气道正压通气(BiPAP)治疗急性左心功能衰竭(ALHF)时不同呼吸机参数的治疗效果。方法:80例急性左心衰患者随机分为高吸气压组(高IPAP组)和低吸气压组(低IPAP组)各40例,两组均给予强心、镇静、利尿、血管扩张药、解痉平喘等常规治疗。高IPAP组给予15～20cmH2O的吸气压,吸氧浓度(FiO2)为60%～80%,2h后改为低浓度(30%～40%)的通气参数;低IPAP组给予8～15cmH2O的吸气压,吸氧浓度(FiO2)为60%～80%的通气参数。比较两组临床症状、体征、血气分析变化。结果:两组患者临床症状、体征、血气等较治疗前明显改(P<0.05):高IPAP组较低IPAP组改善明显(P<0.05)。高IPAP组总有效率高于低IPAP组(P<0.05)。结论:急性左心衰竭BiPAP治疗过程中,采用较高吸气压(15～20cmH2O)、2h内先吸入高浓度氧(60%～80%),后改为低浓度氧(30%～40%)的通气方法较低吸气压(8～15cmH2O),吸高浓度氧(60%～80%)的通气方法疗效更好。

Compare the Treatment-effects of Different Ventilation Index on Acute Left Failure with Bilevel Noninvasive Positive Pressure Ventilation

Objective:To compare the treatment-effects of different index on acute left heart failure with bi-level noninvasive positive pressure ventilation.Methods:Eighty cases of ALHF were randomly divided into high IPAP group and low IPAP group.The two groups were both given the conventional treatment such as cardiac, sedation, diuretics, the vasodilatation medicine, antispasmodic and an tiasthmatie.The high IPAP group was given bi-level noninvasive positive pressure ventilation on high IPAP(15~20 cm H2O),with 60%~80%FiO2 at beginning,2 hours later revised the FiO2 to 30%~40%;The low IPAP group was given low IPAP (8~15 cm H2O),with 60%~80% FiO2 during the whole process.Clinical symptoms, signs, blood gas analysis and adverse reactions were observed.Results:In the two group, the clinical symptoms, signs and blood gas were much improved before treatment(P<0.05),the high IPAP group was better than the low IPAP group (P<0.05).The total effective rate of high IPAP group was higher than the rate of low IPAP group(P<0.05).Conclusions:The treatment-effects of bi-level noninvasive positive pressure ventilation on high IPAP(15~20 cmH2O),with 60%~80%FiO2 at begirming and 2 hours later revised the FiO2 to 30%~40% is better than the low IPAP group which with IPAP 8~15 cm H2O and 60%~80% FiO2 on the whole process.