论文部分内容阅读
目的探讨急性心源性肺水肿(ACPE)的最佳无创通气策略。方法对42例ACPE患者行无创双水平正压通气(BiPAP)治疗,滴定式调节呼气末正压(PEEP)水平,2 h后,执行一项15 min脱机试验,成功组留在普通病房,失败组行插管并转入ICU,比较两组治疗前后临床表现及动脉血气结果。多元线性回归分析评估治疗前平均动脉压(MAP)等因素与疗效的关系。结果成功组30例,失败组12例,成功组中无一例插管。成功组治疗前MAP、氧合指数(OI)明显高于失败组(P=0.000,P=0.020)、动脉血二氧化碳分压(PaCO2)明显低于失败组(P=0.022)。治疗前MAP,PaCO2是疗效的独立预测因子(P=0.000,P=0.008)。结论短期的BiPAP通气可作为急性心源性肺水肿呼吸衰竭患者的急诊首选治疗措施之一。治疗前MAP过低及存在二氧化碳严重潴留的患者治疗失败率高。15 min的脱机试验可以决定患者是否行插管有创通气。
Objective To investigate the best noninvasive ventilation strategy for acute cardiogenic pulmonary edema (ACPE). Methods 42 cases of ACPE patients underwent noninvasive bi-level positive pressure ventilation (BiPAP) and titration-adjusted positive end expiratory pressure (PEEP). Two hours later, a 15-min off-line test was performed. The patients in the ACPE group remained in the general ward , Failed intubation and intubation into the ICU, compared the clinical performance before and after treatment and arterial blood gas results. Multivariate linear regression analysis evaluated the mean arterial pressure (MAP) before treatment and other factors and the effect of the relationship. Results The successful group of 30 patients, failure group of 12 patients, no case of successful intubation. MAP and oxygenation index (OI) in the successful group were significantly higher than those in the failure group (P = 0.000, P = 0.020), PaCO2 in arterial blood group was significantly lower than that in the failure group (P = 0.022). Before treatment, PaCO2 was an independent predictor of efficacy (P = 0.000, P = 0.008). Conclusion Short-term BiPAP ventilation may be one of the first choice of emergency treatment for patients with respiratory failure due to acute cardiogenic pulmonary edema. Patients with low MAP before treatment and severe retention of carbon dioxide have a high failure rate. A 15-minute off-line test determines whether a patient is intubated for invasive ventilation.