双水平无创正压通气治疗急性左心衰伴呼吸衰竭的最佳压力探讨

目的探讨双水平无创正压通气（BiPAP）治疗急性左心衰竭伴呼吸衰竭的最佳滴定压力。方法对56例急性左心衰竭伴呼吸衰竭患者,在常规治疗基础上联用BiPAP呼吸机治疗,采用从高到低滴定式调节吸气压（IPAP）及呼气压（EPAP）的方法,观察血压、心率、呼吸及肺部罗音的变化,同时测定动脉血气,并进行相关分析,以确定BiPAP治疗急性左心衰竭伴呼吸衰竭的最佳压力并评价其疗效。结果应用BiPAP滴定治疗有效者50例（89.3%）,失败6例（10.7%）,且在IPAP（14.2±3.8）cmH2O,EPAP（6.5±1.8）cmH2O范围内,患者的临床症状及动脉血气较治疗前改善,未出现严重并发症,但有效组与失败组的IPAP及EPAP无统计学差异（P〉0.05）;失败组在治疗前的平均动脉压（MAP）、动脉血PH值、氧合指数（OI）明显低于有效组,可能是影响BiPAP治疗效果的因素。结论应用BiPAP滴定最佳压力治疗急性左心衰竭伴呼吸衰竭可快速改善患者临床症状,纠正缺氧,且不良反应少,是治疗急性左心衰伴呼吸衰竭的一种安全、有效的方法。

Effect of noninvasive bi-level positive airway pressure ventilation on treatment of acute left heart failure complicated with respiratory failure by titration of pressure

Objective To explore the therapeutic effect of the optimum pressure titrated by noninvasive bi-level positive airway pressure ventilation(BiPAP) on acute left heart failure complicated with respiratory failure.MethodsA total of 56 patients with acute left heart failure complicated with respiratory failure that could not improve hypoxemia effectively under conventional therapy used BiPAP to treat them by titrating inspiratory pressure(IPAP) and expiratory pressure(EPAP).The changes of their arterial pressures,heart rates,breath rates,clinical symptoms,physical signs,arterial blood gas results before and after treatment were observed and analyzed to determine the optimum pressure of BiPAP treatment and evaluate the curative effect.Results50 cases were obviously relieved by using BiPAP titration treatment.6 cases had no efficacy.The clinical symptoms and arterial blood gas results improved in range of IPAP(14.2±3.8)cmH2O and EPAP(6.5±1.8)cmH2O after treatment.IPAP and EPAP of both effective group and invalid group had no statistical difference.The mean arterial pressure,PH and oxygenation index of invalid group significantly decreased compared with effective group before treatment,which might influence BiPAP treatment.ConclusionBiPAP treatment by titrating the optimum pressure is safeand effective in acute left heart failure complicated with respiratory failure.