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目的:探讨机械通气在抢救急性肺水肿时的方法和临床疗效。方法:通过分析我院20例急性肺水肿患者机械通气前后体征(血压、心率、呼吸频率)、血气分析(pH、PaO2、SaO2、PaCO2、HCO3-)、X线胸片的变化,并参考相关文献总结机械通气治疗急性肺水肿的方法和效果。有效的机械通气方法包括:高频通气和呼气末正压通气(PEEP)。结果:急性肺水肿并发呼吸衰竭患者机械通气之后1、12h较通气之前的平均血压有所下降,[分别为123.0/74.0、118.0/67.0、129.0/75.5mmHg(1mmHg=0.133kPa),通气后12h与通气前比较,P<0.05]平均心率减慢(分别为98、89、105次/min,通气后12h与通气前比较,P<0.05),平均呼吸频率减慢(分别为22.0、21.0、27.4次/min,均P<0.05),平均SaO2显著改善(分别为91.2%、95.1%、76.2%,均P<0.01)。患者机械通气之后较通气之前PaO2明显增高(从48.8mmHg增加至85.1mmHg),具有统计学意义(P<0.05),其他动脉血气分析指标无明显变化。治疗前后X线胸片提示肺水肿明显改善。结论:正压机械通气是治疗各种原因(包括冠心病急性心肌梗死)引起急性严重左心功能不全的重要辅助措施,严格掌握适应证、密切观察病情、选择合适的通气方法、设置合适的参数,可在短期内使急性肺水肿患者病情改善。
Objective: To investigate the method and clinical efficacy of mechanical ventilation in the rescue of acute pulmonary edema. Methods: The changes of blood gas, heart rate and respiratory rate, blood gas analysis (pH, PaO2, SaO2, PaCO2, HCO3 -) and X-ray were analyzed before and after mechanical ventilation in 20 patients with acute pulmonary edema in our hospital. Literature summarizes the method and effect of mechanical ventilation in the treatment of acute pulmonary edema. Effective mechanical ventilation methods include: high-frequency ventilation and positive end expiratory pressure (PEEP). Results: The mean blood pressure of patients with acute pulmonary edema complicated with respiratory failure after mechanical ventilation at 1 and 12 hours was lower than that before ventilation ([123.0 / 74.0,118.0 / 67.0,129.0 / 75.5mmHg (1mmHg = 0.133kPa] respectively] Compared with before ventilation, P <0.05], the average heart rate slowed down (98,89,105 times / min, 12h after ventilation, respectively, compared with those before ventilation, P <0.05) and the average respiratory rate decreased (22.0,21.0, 27.4 times / min, all P <0.05). The average SaO2 was significantly improved (91.2%, 95.1%, 76.2%, P <0.01, respectively). Before mechanical ventilation, PaO2 was significantly increased (from 48.8mmHg to 85.1mmHg), with statistical significance (P <0.05). There was no significant change in other arterial blood gas analysis indexes. X-ray before and after treatment prompted significant improvement of pulmonary edema. Conclusions: Positive pressure mechanical ventilation is an important adjuvant for the treatment of acute severe left ventricular dysfunction due to various causes, including acute myocardial infarction (CHD). Strict indications are needed to observe the condition closely. Appropriate ventilation methods are selected to set appropriate parameters , In a short period of time so that patients with acute pulmonary edema condition improved.