机械通气辅助治疗急性心肌梗死合并急性肺水肿

目的坪估机械通气对急性心肌梗死合并急性危重型肺水肿患者的辅助治疗效果。方法回顾性分忻52例接受经口气管捅管机械通气辅助治疗急性心肌梗死合并肺水肿患者的临床资料，比较机械通气治疗前再患者的临床表现、肺部X线片、动脉血气[动脉血氧分压（partial pressure of oxygen in artery，PaO2），动脉血二氧化碳分胝（partial pressure of carbon dioxide in artery，PaCO2）及pH值]的变化和血浆中的利钠肽（B-type natriuretic peptide．BNP）及高敏C反应蛋白（high sensitivitv C reactive protein．hs-CRP）的浓度变化，比较机械通气前与脱机24h后急性生理学及慢性健康状况评分Ⅲ（acute physiology and chronic health evaluation Ⅲ．APACHEⅢ）评分：结果机械通气30min后，所有患者均良好耐受，呼吸困难明显缓解；心半和呼吸频率明显下降，动脉血气指标明显改善；50例患者APACHEⅢ评分机械通气前与脱机后24h比较，差异有统计学意义[（69．8±6．4）分比（8．7±1．6）分，t=27．49，P〈0．01]。所有患者机械通气72h～96h停用升压药；所有患者于72h复查肺部x线片，45例提示肺水肿缓解或消退，7例好转。52例患者中50例患者均在12d内脱离呼吸机，生命征象平稳：2例患者撤机前（机械通气第7d）突发心跳停止死亡：通气后30min、通气72h及脱机前血浆BNP和hs-CPP浓度比通气前明显降低，结论机械通气能有效缓解急性心肌梗死合并急性危再型肺水肿患者的症状、低氧血症和心功能。

Effects of mechanical ventilation in patients with acute myocardial infarction accompanied with pulmonary edema

Objectives To evaluate the effects of mechanical ventilation on patients with acute pulmonary edema accompanied with acute myocardial infarction.Methods Data from 52 patients admitted to the coronary care unit for acute cardiogenic pulmonary edema caused by acute myocardial infarction were retrospective analyzed.All patients received mechanical ventilation based on routine therapies.Changes of symptoms,lung X-ray,artery blood gas and B-type natriuretic peptide(BNP),high sensitivity C-reactive protein(hs-CRP...