无创正压通气治疗急性心肌梗死合并急性肺水肿的疗效观察  

Treatment of acute myocardial infarction complicating acute pulmonary edema with noninvasive positive-pressure ventilation

作　　者：赵静[1] 王其新[1] 于海初[1] 

机构地区：[1]青岛大学医学院附属医院急诊内科,青岛266003

出　　处：《中国循证心血管医学杂志》2011年第2期108-111,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的探讨无创正压通气治疗急性心肌梗死并发急性肺水肿的疗效。方法选择60例急性心肌梗死并发急性肺水肿患者,随机分为两组,常规治疗组(n=30)给予普通面罩吸氧(4～6L/min)及改善心肌缺血及心功能等常规治疗;BiPAP治疗组(n=30)在常规治疗的基础上采用BiPAPST-D-30呼吸机经鼻罩双向正压通气治疗。观察治疗前后患者心率、呼吸频率、血压、动脉血气指标及血清BNP变化。结果两组患者在治疗后呼吸频率、动脉血氧分压(PaO2)、心肌氧耗均有所改善。BiPAP治疗组正压通气治疗2h、24h呼吸频率、PaO2、收缩压、心肌耗氧量的改善均优于常规治疗组,差异有统计学意义(P<0.05～0.01);在治疗72h后,BiPAP治疗组血清BNP水平显著低于常规治疗组(P<0.01)。与常规治疗组比较,BiPAP治疗组气管插管率、病死率显著降低,住院时间显著缩短,差异均有统计学意义(P均<0.05)。结论 BiPAP鼻罩式双向正压机械通气可快速改善急性心肌梗死患者肺水肿、低氧血症及心功能。Objective To discuss the curative effect of noninvasive positive-pressure ventilation(NIPPV) on acute myocardial infarction(AMI) complicating acute pulmonary edema(APE).Methods The patients(n=60) with AMI complicating APE were chosen and randomly divided into two groups.The control group(n=30) were given oxygen by facemask(4~6 L/min) and routine therapy for relieving myocardial ischemia and improving heart function.The treatment group(n=30) was given bidirectional NIPPV through nasal mask with BiPAP ST-D-30 respirator on the base of routine therapy.The heart rate,breathing rate,blood pressure,PaO2 and changes of serum brain natriuretic peptide(BNP) were observed before and after the treatment.Results After treatment,the breathing rate,PaO2 and myocardial oxygen consumption volume were alleviated in two groups.In the treatment group,the improvement of breathing rate,PaO2,systolic pressure and myocardial oxygen consumption volume were superior to those in the control group(P<0.05~0.01) 2 hours and 24 hours after NIPPV.After treatment for 72 hours,the level of serum BNP was significantly lower in the treatment group than that in the control group(P<0.01).The rate of endotracheal intubation and mortality decreased significantly,and hospital stay was significantly shortened in the treatment group compared with the control group(all P<0.05).Conclusion The bidirectional NIPPV through nasal mask can rapidly alleviate pulmonary edema and hypoxemia and improve heart function in the patients with AMI.

关 键 词：心肌梗死 急性肺水肿 正压呼吸 

分 类 号：R541.4[医药卫生—心血管疾病]