无创正压通气治疗急性心源性肺水肿36例_0.docVIP

无创正压通气治疗急性心源性肺水肿36例 作者：陈增瑞　郑孝敬　周朝阳　甘永雄 【关键词】 无创正压通气;急性心源性肺水肿;左心衰竭 ［摘要］ 目的评价无创正压通气 治疗 急性心源性肺水肿的疗效。 方法 选择36例急性心源性肺水肿患者，在高流量吸氧及常规药物治疗不能纠正缺氧时，经面罩给予无创正压通气，观察治疗前、治疗后0.5h、1h、2h后临床症状、体征和动脉血气 分析 的变化。结果经面罩无创正压通气治疗后，36例患者中32例（88.89%）临床症状、体征明显改善，血气分析中PaO 2 明显升高（P0.01）、PaCO 2 有所下降（P0.05），避免了进一步有创机械通气治疗带来的损伤和 经济 负担;4例（11.11%）经无创正压通气治疗无效，改为经口气管插管机械通气;死亡2例。结论 应用 无创正压通气可明显改善急性心源性肺水肿患者的症状、体征和血气分析结果，可作为急性心源性肺水肿安全、快速、有效的治疗手段之一。 　　［关键词］无创正压通气;急性心源性肺水肿;左心衰竭 　　Clinical study of non-invasive positive pressure ventilation in the treatment of36patients with acute cardiogenic pulmonary edema 　　［Abstract］ Objective To estimate the efficacy of non-invasive positive pressure ventilation（NIPPV）in the treatment of the patients with acute cardiogenic pulmonary edema（ACPE）.Method36adult patients with ACPE who were of no effect with high flow oxygen and routine drugs were treated with NIPPV by face masks. The changes of parameters in-cluding symptom，sign and arterial blood gas were observed before treatment and at thirty minutes，one hour，two hours after treatment.Results After NIPPV，thirty two of thirty six cases（88.9%）were improved significantly.Respiratory rate and heart rate became slow，moist rale of lung decreased，PaO 2 was higher（P0.01）and PaCO 2 was lower（P0.05）.Four cases（11.1%）who had no response to NIPPV were converted to tracheal mechanical ventilation.Conclusion NIPPV is an effective and safe way to treat adult patients with ACPE. 　　［Key Words］ non-invasive positive pressure ventilation（NIPPV）;acute cardiogenic pulmonary edema（ACPE）;left-sided heart failure 　　急性弥漫性心肌损害和急性心脏负荷过重患者可诱发急性肺水肿，表现为端坐呼吸、烦躁不安、皮肤湿冷、咳粉红色泡沫痰、心率增快、奔马律、两肺广泛湿口罗音、哮鸣音等，严重者可出现心源性休克或呼吸衰竭，如不及时处理可导致全身脏器不可逆的损害。多数患者通过给氧和常规药物治疗后病情得到控制，但少部分患者疗效不佳，需机械通气。传统上采用经气管插管有创机械通气，但近年来，随着无创正压通气（non-invasive positive pressure ventilation，NIPPV）在急慢性呼吸衰竭中取得较满意的疗效，其 亦被用于急性心源性肺水肿（acute cardiogenic pul-monary edema，ACPE）。本文对我科4年来用NIPPV救治急性心源性肺水肿患者，取得了较满意的疗效。现报道如下。 　　1资料和方法 1.1 一般资料 　　选择自2002年1月～2005年12月我科收治的符合入选标准患者36例，其中男性22例，女性14例，年