心脏病患者的正压通气─心肺相互作用讲解.ppt

无创CPAP和BiPAP能够减轻心脏应激 CPAP能够减轻急性心源性肺水肿(ACPE)患者的心脏缺血 Rasanen et al. Am J Cardiol 55:296-300, 1985 如果CPAP能够消除ACPE患者的胸腔内负压，才能发挥有益作用 Rasanen et al. Chest 87:158-62, 1985 面罩CPAP可避免ACPE患者气管插管 Bersten et al. N Engl J Med 325:1825-30, 1991 面罩BiPAP以及PSV可改善ACPE患者氧合，避免气管插管 Massip et al. Lancet 356:2126-32, 2000 Giacomini et al. Chest 123:2057-61, 2003 Nava et al. Am J Respir Crit Care Med 168:1432-7, 2003 Ferrer et al. Am J Respir Crit Care Med 168:1438-44, 2003 CPAP和BiPAP对ACPE具有相似的有益作用 Park et al. Crit Care Med 32:2407-15, 2005 面罩BiPAP能够改善OSA患者的左心室功能 Kaneko et al. N Engl J Med 348:1233-41, 2003 急性心梗时的CPAP Rasanen et al. Chest 1985； 87: 158-162 CPAP对CHF患者ITP的影响 Naughton MT, Rahman A, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circ 1995; 91: 1725-1731 CPAP对CHF患者ITP的影响 Naughton MT, Rahman A, Hara K, et al. Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circ 1995; 91: 1725-1731 CPAP改善CHF患者的LV功能 24名合并CHF的OSA患者 夜间CPAP x 1 mth vs. 对照组 夜间CPAP组病情改善 OSA发作减少 收缩压降低 (126 to 116 mmHg) 心率减慢 (68 to 63 bpm) LV射血分数改善 (25 to 34%) LV收缩末内径减小 (55 to 53 mm) Kaneko et al. N Engl J Med 2003; 348: 1233-1241 CPAP改善CHF患者的LV功能 Kaneko et al. N Engl J Med 2003; 348: 1233-1241 ACPE时的面罩CPAP 39名ACPE患者随机分为面罩CPAP组或氧疗组(FiO2 0.4) 研究持续24 h 30分钟后呼吸频率及PaCO2下降 24 h时两组患者生理指标相似 气管插管比例 CPAP组 0/20 对照组 7/19 Bersten et al. N Engl J Med 1991; 325: 1825-1830 ACPE时的面罩CPAP Bersten et al. N Engl J Med 1991; 325: 1825-1830 CPAP O2 ACPE的无创通气 Masip, et al. Lancet 2000; 356: 2126-2132 Control (n = 18) NIPSV (n = 19) ACPE的无创通气 Masip, et al. Lancet 2000; 356: 2126-2132 ACPE的无创机械通气 Ferrer M,Esquinas A, Leon M et al. Noninvasive ventilation in severe hypoxemic respiratory failure: a randomized clinical trial. Am J Respir Crit Care Med 2003; 168: 1438-1444 ACPE的无创机械通气 Ferrer M,Esquinas A, Leon M et al. Noninvasive ventil