三种无创通气模式在急性心源性肺水肿早期救治中的应用分析  

Clinical Study on Early Efficacy of Three Modes of Noninvasive Ventilation on Patients with Acute Cardiogenic Pulmonary Edema

作　　者：任天成[1] 侯传勇[1] 张明[1] 刘荣明[1] 魏芳玲[1] 

机构地区：[1]南京医科大学附属江宁医院急诊医学科,江苏省南京市211100

出　　处：《中国全科医学》2015年第8期937-940,共4页Chinese General Practice

基　　金：南京市医学科技发展项目(YKK13213)

摘　　要：目的比较早期无创通气(NIV)模式中比例辅助通气(PAV)、双水平正压通气(Bi PAP)和持续气道正压通气(CPAP)救治急性心源性肺水肿(ACPE)患者的临床疗效。方法选取2010年1月—2013年12月南京医科大学附属江宁医院急诊医学科收治的ACPE患者80例,采用随机数字表法将患者分为对照组、PAV组、Bi PAP组和CPAP组,各20例。4组患者均给予常规治疗,PAV组、Bi PAP组和CPAP组在常规治疗的基础上,分别给予PAV、Bi PAP和CPAP治疗。记录4组患者治疗前和治疗后2 h心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、B型脑钠肽(BNP)和动脉血气〔p H、二氧化碳分压(Pa CO2)、血氧分压(Pa O2)、血氧饱和度(Sp O2)〕、气道峰压(PIP)、气管插管率和NIV并发症发生率。采用视觉模拟评分(VAS)评定患者舒适度。结果治疗前,4组HR、RR、MAP、BNP和p H、Pa CO2、Pa O2、Sp O2比较,差异均无统计学意义(P>0.05);治疗后2 h,4组p H比较,差异无统计学意义(P>0.05),4组HR、RR、MAP、BNP和Pa CO2、Pa O2、Sp O2比较,差异均有统计学意义(P<0.05),其中PAV组、Bi PAP组和CPAP组上述指标均高于对照组(P<0.05)。PAV组、Bi PAP组和CPAP组PIP和VAS比较,差异均有统计学意义(P<0.05),其中Bi PAP组和CPAP组PIP和VAS均高于PAV组(P<0.05)。4组气管插管率比较,差异有统计学意义(P<0.05),其中PAV组、Bi PAP组和CPAP组气管插管率均低于对照组(P<0.05)。PAV组、Bi PAP组和CPAP组并发症发生率比较,差异均无统计学意义(P>0.05)。结论尽早应用NIV可迅速改善ACPE患者的生理学参数和动脉血气指标,缓解呼吸困难;PAV气道峰压较低、同步性和舒适性好,安全、有效,更易为患者接受。Objective To compare the clinical efficacy of the three modes of noninvasive ventilation including proportional assist ventilation（ PAV）, bilevel positive airway pressure（ Bi PAP） and continuous positive airway pressure（ CPAP） on patients with acute cardiogenic pulmonary edema（ ACPE）. Methods 80 patients with ACPE visiting Department of Emergency,the Jiangning Hospital Affiliated to Nanjing Medical University from January,2010 to December,2013 were selected and randomly divided into four groups with 20 patients in each： control group,PAV group,Bi PAP group and CPAP group. In addition of the routine treatment in all the four groups,PAV,Bi PAP and CPAP groups received added PAV,Bi PAP and CPAP respectively. Heart rate（ HR）, respiratory rate（ RR）, mean arterial pressure（ MAP）, B- type natriuretic peptide（ BNP）, arterial blood gas change 〔p H, pressure of arterial carbon dioxide（ Pa CO2）, blood oxygen pressure（ Pa O2）,blood oxygen saturation（ Sp O2） 〕,peak airway pressure（ PIP）,endotracheal intubation rate and incidence of complication of NIV were measured before and 2 hours after therapy. Patients＇ comfort degree was measured by Visual AnalogueScale（ VAS）. Results Before treatment,the differences in HR,RR,MAP,BNP and p H,Pa CO2,Pa O2,Sp O2 in the four groups were all not statistically significant（ P 0. 05）; 2 h after treatment,p H was still not（ P 0. 05）,but HR,RR,MAP,BNP and Pa CO2,Pa O2,Sp O2 turned significant（ P 0. 05） and the above indexes in PAV,Bi PAP and CPAP were all significantly higher than those in control（ P 0. 05）. PIP and VAS were significantly different in the groups of PAV,Bi PAP and CPAP（ P 0. 05） and the scores in Bi PAP and CPAP were significantly higher than those in PAV（ P 0. 05）.Endotracheal intubation rate in the four groups was significantly different（ P 0. 05） and it was all significantly lower in PAV,Bi PAP and CPAP than that in control group（ P 0. 05）. No significant difference was found in the inc

关 键 词：肺水肿 连续气道正压通气 比例辅助通气 双水平正压通气 

分 类 号：R541.63[医药卫生—心血管疾病]