重症心源性肺水肿伴休克患者的机械通气治疗  

The treatment of patients with severe cardiogenic pulmonary edema and shock via mechanical ventilation

作　　者：朱蕾[1] 侯静静[1] 王齐兵[2] 钮善福[1] 

机构地区：[1]复旦大学附属中山医院呼吸科,上海200032 [2]复旦大学附属中山医院心内科,上海200032

出　　处：《国际呼吸杂志》2006年第8期564-567,共4页International Journal of Respiration

摘　　要：目的研究重症心源性肺水肿伴休克患者机械通气（MV）治疗时通气压力的选择对预后的影响。方法将符合标准的22例患者分为两组：对照组9例，常规给予较低通气压力和加强药物治疗；治疗组13例，适当增加通气压力。观察血压、临床症状和动脉血气的变化。结果调整MV后30分钟时，治疗组收缩压迅速由（95±12）mmHg升至（130±15）mmHg（P〈0．001），呼吸频率（RR）由（38±11）次／min降至（27±6）次／min（P〈0．005），心率（HR）由（126±15）次／min降至（105±12）次／min（P〈0．001）；对照组上述指标变化不明显。2小时后治疗组的升压药用量减少（70±15）％，对照组则增加（20±5）％；同时在吸氧浓度不变的情况下，治疗组的Pa（-）：由（81±12）mmHg升至（140±15）mmHg（P〈0．001），明显高于对照组PaO2的改善。24～48小时内治疗组11例患者（85％）停用升压药，对照组2例（22％）停用。最终治疗组100％的患者好转出院，对照组为45％（P〈0．05）。结论与低压力通气相比，适当增加MV通气压力不仅可迅速改善重症心源性水肺肿伴休克患者的低氧血症，也可迅速升高血压，改善心功能，降低病死率。Objective To investigate the influence of mechanical ventilation pressure on the prognosis of patients with severe cardiogenic puh-nonary edema（CPE） and shock. Methods Twenty-two patients included the study were divided into two groups： control group and treatment group. Two groups were comparable with regard to baseline physiological and clinical characteristics（age, medical conditions）. The former received general treatments and lower MV pressure, the latter received higher MV pressure based general treatment. The bloodpressure（BP）, symptoms, signs, and artery blood gases were gathered and analyzed. Results After 30 mimutes of treatment, systolic blood pressure improved rapidly from （95 ±12） mmHg to （130±15）mmHg（ P〈0. 001）,respiratory rates（RR） decreased from （38± 11）times/min to （27±6） times/min （ P 〈0. 005）, heart rates（HR） decreased from （ 126± 15） times/min to （ 105± 12） times// min（ P〈0. 001） in treatment group; while there were not marked changes in control group. 2 hours later, the dosage of drugs which elevating BP were decreased about （70± 15） % in treatment group,but it increased about （20 ± 5）% in control group ; when given oxygen concentrations were not changed, PaO2 rose from （81±12）mmHg to （140±15）mmHg in treatment group （ P〈0. 001） and improved more markedly than that in control group （ P〉0.05）. And the drug was stopped in 11 cases （85%） of treatment group, and only 2 cases （220%） of control group within 24±48 hours. 100%patients of treatment group were discharged from hospital,but it only 45% in control group（ P〈0.05）. Conclusions Suitable elevation of MV pressure can rapidly improve hypoxemia, hypotension and cardiac function of the patients with severe cardiogenic pulmonary edema and shock than lower MV pressure,and correspondingly reduce the mortality.

关 键 词：心源性肺水肿 休克 低氧血症 心功能 机械通气 

分 类 号：R541.63[医药卫生—心血管疾病] R563.8[医药卫生—内科学]