有创与无创序贯机械通气治疗老年急性心源性肺水肿的临床研究  

Sequential non-invasive following invasive mechanical ventilation in old patients with acute pulmonary edema

作　　者：于萍[1] 张代富[1] 牛惠燕[1] 祁炜罡[1] 俞莉[1] 包丽娟[1] 

机构地区：[1]上海同济大学附属东方医院心内科

出　　处：《中国心血管病研究》2006年第2期104-106,共3页Chinese Journal of Cardiovascular Research

摘　　要：目的探讨有创无创序贯通气治疗老年急性心源性肺水肿的技术可行性并评价其效果。方法22例患者分为两组:序贯治疗组,12例患者,常规治疗的基础上,以同步间歇通气+压力支持通气(SIMV+PSV)方式行机械通气,待肺水肿好转后拔除气管插管,改双水平气道正压(BiPAP)支持通气并撤机;对照组,10例患者,以SIMV+PSV方式撤机。对照分析两组病例的通气、氧合指标、有创机械通气时间和总的机械通气时间。结果序贯治疗组和对照组患者有创机械通气时间分别是(2.1±0.8)d和(7.1±3.7)d,总机械通气时间分别是(3.8±0.8)d和(7.1±3.7)d,呼吸机相关肺炎1例和5例,院内死亡例数分别是2例和3例。结论老年急性心源性肺水肿患者,肺水肿好转后早期拔管,改用经鼻面罩双水平气道正压通气缩短机械通气时间,减少呼吸机相关肺炎的发生。Objective To estimate the feasibility and efficacy of sequential non-invasive mechanical ventilation following invasive mechanical ventilation. Methods 22 elderly patients with cardiogenie pulmonary edema were divided into two groups. All patients received routine drug therapy and endotraeheal intubation. Twelve patients in sequential therapy group were ventilated by sequent invasive and non-invasive mechanical ventilation. Other 10 cases received in- vasive mechanical ventilation therapy. Results The time of invasive mechanical ventilation was （2.1±0.8） and （7.1± 3.7）days in sequential therapy and control group（P〈0.05）. Total mechanical ventilation time was （3.8±0.8） and （7.1± 3.7 ） days respectively（P〈0.05 ）, the incidence of mechanical ventilation related pneumonia were 1/12 and 5/10, while in hospital mortality were 2/12 and 3/10 respectively. Conclusion Sequential therapy with invasive followed by noninvasive mechanical ventilation in elderly patients with pulmonary edema benefit these patients.

关 键 词：通气机 机械 急性心源性肺水肿 老年人 

分 类 号：R541[医药卫生—心血管疾病]