BiPAP鼻罩式机械通气治疗左心衰竭  

Treatment of BiPAP mechanical ventilation by nasal mask on left ventricular failure

作　　者：王凤芝[1] 冀锐锋[1] 张雪娥[1] 赫崇平[1] 巩书文[1] 徐秀峰[1] 

机构地区：[1]山西医科大学第二医院心内科,太原030001

出　　处：《中华心血管病杂志》2001年第2期100-103,共4页Chinese Journal of Cardiology

基　　金：山西省科委科技攻关项目资助(972180)

摘　　要：目的　探讨BiPAP鼻罩式双向正压机械通气治疗左心衰竭的疗效、适合的通气压力等具体方法 ,了解其对血液动力学的影响。方法　对 35例各种病因所致严重左心衰竭患者在常规药物治疗基础上采用BiPAPST D 2 0、ST D 30呼吸机经鼻罩双向正压通气 ,以流量触发 ,压力支持 ,所给吸气压 8～ 15cmH2 O ,呼气压 2～ 5cmH2 O ,氧浓度 2 8%～ 35 % ,患者尽量闭口呼吸。对其中 8例患者插入Swan～Ganz漂浮热稀释导管 ,用HPMI16 6A型心电监护仪及配套血液动力学插件测定及计算各项血液动力学指标。同时与 35例常规药物治疗组进行对比。结果　BiPAP组经鼻罩式机械通气后所有患者呼吸频率减慢 ,心率下降 ,呼吸困难缓解 ,治疗总有效率为 10 0 % ,对血压无明显影响 ,呼吸困难开始缓解时间为 10min～ 3h ;对 8例BiPAP鼻罩式机械通气患者血液动力学监测显示 ,平均肺动脉压和肺毛细血管楔压下降 ,心指数无明显变化 ,心搏指数增加。对照组在相应时间治疗总有效率仅为6 3.33%。结论　BiPAP鼻罩式双向正压机械通气是治疗左心衰竭的快速有效方法。Objective To investigate the role and methods of Bi level positive airway pressure (BiPAP) mechanical ventilation by nasal mask on left ventricular failure (LVF). Methods BiPAP group: 35 patients with severe LVF from various causes were treated by nasal BiPAP ST D 20, ST D 30 accessory machines with traditional drugs. During the management, the patients inhaled and exhaled with mouth closed. The machines were triggered by flow and maintained with pressure. Both the inspiratory pressure and expiratory pressure were 8-15 cm H 2O, 2-5 cm H 2O, respectively. The used oxygen density was 28%-35%. The hemodynamic data were measured by (HPMI166A) cardiac electric record insturment and paired hemodynamic software in 8 patients who were inserted with Swan Ganz floating hot dilated catheter. Control group: 35 patients were treated with traditional drugs alone, and the results were compared with those of BiPAP group. Results Dyspnea were relieved in all patients in BiPAP group, both the respiratory rate and heart rate were slowed [from (30.33±8.98)/min to (21.12±3.03)/min, and from (98.21±20.62)/min to (82.11±7.93)/min, respectively]. There were no change in blood pressure. The dyspnea is markly relaxed about ten minutes to three hours after the administration of BiPAP. The effiency rate is 100%, while the total efficiency rate is only 63.33% in control group. The hemodynamic records indicated that mean pulmonary artery pressure (MPAP) and pulmonary capillary wedge pressure (PCWP) were decreased [from (29.96±3.15) mm Hg to (21.40±2.81) mm Hg and from (19.22±1.34) mm Hg to (12.18±1.77) mm Hg, respectively]. Cardiac index (CI) had no change, but stroke index (SI) was increased (from 29.19±3.14 to 34.46±4.48 ). Conclusion The use of BiPAP mechanical ventilation therapy is feasible and effective on LVF.

关 键 词：心力衰竭 充血性 正压呼吸 

分 类 号：R541.61[医药卫生—心血管疾病]