摘要
目的研究无创正压通气(NIPPV)对重症心源性肺水肿的治疗效果。方法42例重症急性心源性肺水肿(NYHA心功能分级Ⅲ～Ⅳ级)患者随机分为两组,对照组17例,采用常规治疗;治疗组21例,在常规治疗的基础上给予NIPPV,观察临床表现、胸部X线片、无创心功能指标和动脉血气变化。4例因放弃治疗而退出。结果NIPPV后30min内,905%的患者呼吸困难明显改善,呼吸频率由(38±8)次/min降至(26±5)次/min(P<005),心率由(124±20)次/min降至(93±25)次/min(P<005),4例(19%)低血压患者血压迅速回升,952%的患者24h内咳嗽、咳痰等症状显著好转,肺部湿音基本消失,总体好转速度明显优于对照组。在吸氧流量相同的情况下,治疗组1h后PaO2由(62±10)mmHg升至(78±17)mmHg(P<005),2～6h后升至(96±21)mmHg(P<005),PaO2升高的速度和幅度均优于对照组;脱机时,治疗组在吸空气条件下PaO2(79±8)mmHg(P<005),PaCO2和pH也逐渐恢复正常。95%的患者在24～48h内脱离呼吸机,总有效率100%。心功能指标显著改善。结论与常规治疗相比,NIPPV可迅速改善心功能,并更快改善肺水肿和低氧血症。
Objective To evaluate the effects of noninvasive positive pressure ventilation (NIPPV) on acute cardiogenic pulmonary edema.Methods 42 patients with severe acute cardiogenic pulmonary edema were randomly divided into two groups.17 patients in control group just received conventional treatment and 21 patients in treatment group received NIPPV based on conventional treatments.The symptoms,signs,chest X-ray appearance,arterial blood gas analysis and cardiac function were monitored and analyzed.Results 30 minutes after noninvasive positive pressure ventilation dyspnea was improved markedly,respiratory rates decreased from ^(38±8) times/min to (26±5)times/min (P<0.05),heart rates decreased from (124±20)times/min to ^(93± 25)times/min (P<0.05).The blood pressure of 4 patients with hypotension was improved rapidly and the others remained stable.Cough,expectoration and moist rale disappeared in 24 hours in 95.2% of the patients.The patients in treatment group improved more rapidly than those in control group.The arterial blood gas analysis showed that PaO_~2 rose from (62±10)mm Hg to (78±17)mm Hg after l hours (P<0.05),and (96±~21)mm Hg after 2～6 hours (P<0.05).PaCO_2 and pH were also gradually improved to normal ranges.20 patients were weaned from ventilator in 24～48 hours with an efficacy rate of 100%.Conclusion NIPPV can improve cardiac function,pulmonary edema and hypoxemia more rapidly than conventional therapy.
出处
《中国呼吸与危重监护杂志》
CAS
2005年第1期38-40,44,共4页
Chinese Journal of Respiratory and Critical Care Medicine
