无创机械通气治疗急性心源性肺水肿临床研究

目的研究和探讨应用无创机械通气(NMV)治疗急性心源性肺水肿(ACPE)的临床价值。方法将大连市中心医院2002-01~2004-04收治的60例ACPE患者随机分为常规治疗组和NMV组。NMV组患者在给予常规药物治疗基础上,通过面罩与呼吸机相连,给予压力支持通气(PSV) 呼气末正压(PEEP)通气模式,PSV8~15cmH2O(1cmH2O=0·098kPa),PEEP5~8cmH2O;常规治疗组给予Venturi面罩吸氧。在治疗第1、2、3、4、12h分别测量血气及血压、心率、呼吸频率等临床指标。将两组数据进行对比。结果NMV组30例患者有5例改行气管插管(16·7%),对照组有1例患者因确诊为肺纤维化而被排除,29例有12例改行气管插管(41·4%)(P=0·036)。NMV组的症状缓解时间40(5~77)min明显短于对照组145(49~263)min(P<0·01)。NMV在第1个2h内可迅速改善氧合。两组患者的住ICU时间、住院时间和病死率差异无显著性意义。结论与常规治疗相比,应用无创机械通气治疗急性心源性肺水肿能快速改善氧合、动脉血二氧化碳分压及呼吸困难,减少气管插管,值得在临床推广使用。

Clinical study on treatment of acute cardiogenic pulmonary edema by noninvasive mechanical ventilation

Objective To evaluate the clinical applications of noninvasive mechanical ventilation in the treatment of acute cardiogenic pulmonary edema. Methods From Jan.2002 to Apr.2004 60 patients in Dalan Municipal Central Hospital were randomly assigned to receire conventional oxygen therapy or NMV supplied by a standard ventilator through a face mask,with adjustment of pressure support at 8-15 cm H_2O in addition to a positive end-expiratory pressure of 5-8 cmH_2O.Blood gas and vital signs were obtained at 1 h,2 h,3 h,4 h,and 12h.Results Endotracheal intubation was required in 5(16.7%)of 30 patients assigned to receire NMV and in 12(41.4%)of 29 assigned to receive conventional oxygen therapy(P=0037). Resolution time was significantly shorter in the NMV groupmedian 40(5~77)vs145(49~263)min,P<0.01.NMV led to a rapid improvement in oxygenation in the first 2 h.There were no differences in hospital and ICU length of stay or mortality.Conclusion In this study of acute cardiogenic pulmonary edema,NMV is superior to conventional oxygen therapy.It can be recommended for clinical use.