无创正压通气治疗急性中毒性肺水肿的临床研究  

The Clinical Research of Noninvasive Positive Pressure Ventilation (NIPPV) for the Treatment of Acute Toxic Pulmonary Edema

作　　者：李小强[1] 陈运超[1] 刘移民[1] 

机构地区：[1]广州市第十二人民医院重症监护室,广州510620

出　　处：《热带医学杂志》2009年第4期420-421,435,共3页Journal of Tropical Medicine

摘　　要：目的探讨无创正压通气(noninvasive positive pressure ventilation,NIPPV)对急性中毒性肺水肿的临床效果。方法选择符合中毒性肺水肿诊断并且氧合指数(oxygenation index,PaO2/FiO2,OI)低于300mmHg的患者48例,随机分成无创正压通气组(NIPPV组)25例及常规治疗组23例;NIPPV组在常规治疗的基础上给予以经面罩接呼吸机辅助通气(通气模式ASB+PEEP)。结果治疗1h后,NIPPV组的血气分析结果、氧合指数、呼吸频率(respiratory rate,RR)、氧饱和度(blood oxygen saturation,SaO2)均较治疗前显著改善(P<0.01)。与常规治疗组比较,OI、SaO2明显占优(P<0.01),总住院费用及住院天数也明显少于常规治疗组(P<0.001);同时,NIPPV组的气管插管机械通气率显著低于常规治疗组(P<0.01)。结论急性中毒性肺水肿早期应用无创压力支持通气能迅速改善患者的氧合能力,提高组织氧供,减少并发症,这对提高抢救成功率,改善患者预后有积极作用。Objective To investigate the clinical efficacy of noninvasive positive pressure ventilation （NIPPV） in patients with acute toxic pulmonary edema. Method A total of 48 patients who had diagnosed as acute toxic pulmonary edema with oxygenation index （PaO2/FiO2, OI）〈300 mmHg were enrolled in this study. All patients were randomly assigned in NIPPV group （25 patients） and conventional therapy group （23 patients）. NIPPV group received respirator assisted ventilation through face mask in the basis of conventional therapy （ventilation model is ASB＋PEEP）. Result After therapy for 1 h in NIPPV group, the level of blood gas analysis, OI, respiratory rate （RR） and blood oxygen saturation （SaO2） were significantly improved （P〈0.01）. OI and SaO2 in NIPPV group were faster than those in conventional therapy group （P〈0.01）, and intubation rate and cost of hospitalization were also significantly lower than those in the conventional therapy group（P〈0.001 ）. The mechanical ventilation rate of tracheal intubation in NIPPV group was also significantly lower than that in the conventional therapy group （P〈0.01）. Conclusion The early use of noninvasive positive pressure ventilation in acute toxic pulmonary edema can quickly increase oxygenation and tissue oxygen supply, reduce complications and improve the prognosis for the patients.

关 键 词：中毒性肺水肿 无创正压通气 临床效果 

分 类 号：R655.3[医药卫生—外科学]