有创-无创序贯机械通气对急性心源性肺水肿患者低氧血症和血流动力学的影响

目的:探讨有创-无创序贯机械通气对急性心源性肺水肿患者低氧血症及血流动力学的影响。方法:按照随机数字表法将2013年3月至2015年3月我院收治的49例急性心源性肺水肿患者分为两组,对照组行常规抗心衰治疗联合有创机械通气,观察组接受对照组治疗方案后,再给予无创鼻面罩双水平气道正压通气。比较两组患者治疗前后的动脉血气分析指标及血流动力学指标,以及有创机械通气时间、机械通气总时间、呼吸机相关肺炎(VAP)发生率、再发心衰率及死亡例数。结果:两组患者治疗过程中未出现死亡病例,治疗后,两组患者动脉血气分析指标、血流动力学指标较治疗前不同程度的改善,差异有统计学意义(P0.05),两组患者治疗后的动脉血气分析指标、血流动力学指标比较,差异无统计学意义(P0.05)。观察组患者有创通气时间、通气总时间少于对照组,VAP发生率低于对照组,差异有统计学意义(P0.05),两组患者再发心衰率差异无统计学意义(P0.05)。结论:有创-无创序贯机械通气能有效改善急性心源性肺水肿患者的低氧血症和血流动力学指标,安全有效,作为抢救急性心源性肺水肿的措施具有重要临床价值。

Impact of Sequential Invasive-noninvasive Mechanical Ventilation on Hyoxemia and Hemodynamics in Patients with Acute Cardiac Pulmonary Edema

Objective:To explore the influence of sequential invasive-noninvasive mechanical ventilation on hyoxemia and hemodynamics in patients with acute cardiac pulmonary edema.Methods:49 patients with acute cardiac pulmonary edema treated in our hospital from March 2013 to March 2015 were divided into two groups according to the random number table method. The control group was received routine anti heart failure therapy combined with invasive mechanical ventilation, and the observation group based on the treatment of control group underwent noninvasive nasal mask bi level positive airway pressure ventilation. The comparisons of hyoxemia and hemodynamics parameters of two groups before and after treatment were conducted, and the invasive mechanical ventilation time, total mechanical ventilation time, incidence of VAP, rate of recurrent heart failure and death cases between two groups were compared.Results:There was no deaths in the process of treatment. After treatment, the hyoxemia and hemodynamics parameters of two groups had improvement with different degree, the difference was statistically significant (P<0.05). No statistical difference on hyoxemia and hemodynamics parameters between two groups after treatment was found(P>0.05). The invasive mechanical ventilation time, total mechanical ventilation time of observation group were less than those of control group, and the rate of VAP was less than that of control group, the differences were statistically significant (P<0.05). There was no statistical significance on the rate of heart failure recurrence(P>0.05).Conclusion:Sequential invasive-noninvasive mechanical ventilation can obviously improve the the hyoxemia and hemodynamics in patients with acute cardiac pulmonary edema, which is safe an effective and has important value as the treating measures of acute cardiac pulmonary edema.