持续正气道压通气与双水平正气道压通气治疗急性心源性肺水肿的临床观察

目的 :观察急性心源性肺水肿患者应用无创通气的临床疗效 ,及其对循环参数的影响。方法 :4 0例急性左心衰患者 ,在传统治疗的基础上 ,随机分组给予持续正气道压通气 (CPAP =5cmH2 O)或双水平正压通气 (BiPAP10 / 4cmH2 O) ,观察 2h后患者循环参数改变 ,并记录患者对无创通气的耐受性。结果 :CPAP与BiPAP组在接受无创通气治疗前 ,年龄、心率 (HR)、平均动脉压 (mBP)、心输出量 (CO)、每搏射血量 (SV)、系统循环阻力 (TSR)、血氧饱和度 (SaO2 )等均无统计学差异 ,临床所用速尿、硝普钠剂量无统计差异。患者对CPAP治疗的耐受性明显高于BiPAP(95 %vs 6 5 % ,P=0 .0 14 ) ;分析成功进行无创通气治疗的病例 ,两组患者 2h后HR、mBP、CO、TSR与治疗前均有明显下降 ,P <0 .0 5 ,但SV无明显改变 (P >0 .0 5 )。两组患者SaO2 均有显著升高 ,CPAP组明显高于BiPAP组 (95 %vs 87% ,P <0 .0 0 1)。CPAP与BiPAP两组患者 2h后的循环参数无显著差异(P >0 .0 5 )。结论 :无创通气明显改善心源性肺水肿患者的呼吸功能 ,对患者的治疗是有益的 ,CPAP更易为患者接受。CPAP与BiPAP降低急性心衰患者的心脏前、后负荷 ,综合治疗的结果 ,CO下降明显 ,而SV变化不显著 ,两种通气模式对循环功能的影响无显著差异。

Clinical Observation of Continuous Positive Airway Pressure and Bi-level Positive Airway Pressure in Treatment of Acute Cardiogenic Pulmonary Edema

Objective: To investigate the efficacy of non invasive positive pressure ventilation (NPPV) in the treatment of acute cardiogenic pulmonary edema and its influence on hemodynamic parameters. Methods: 40 patients with acute cardiogenic pulmonary edema were randomly divided into 2 groups on the basis of traditional medicines: continuous positive airway pressure (CPAP) group (CPAP=5cm H 2O) and bi level positive airway pressure (BiPAP) group (BiPAP10/4cm H 2O). Hemodynamic parameters and the tolerance of patients were recorded in 2 hours. Success rate of NPPV were analyzed. Results: Parameters of age, heart rate (HR), mean blood pressure (mBP), cardiac output (CO), stroke volume (SV), total systemic resistance (TSR) and oxygen saturation (SaO 2 ) on admission were similar between 2 groups before NPPV. Dosage of lasix and nitroprusside used were not different statistically. Success rate of patients in CPAP group was higher than that in BiPAP group ( 95% vs 65%, P =0.014). Data with successful NPPV treatment were analyzed then. HR, mBP, CO, TSR dropped dramatically compared with parameters before treatment in both groups ( P <0.05). But SV did not show clear trend of change ( P >0.05). SaO 2 increased in both groups with successful treatment. SaO 2 was higher in CPAP group than that in BiPAP group (95% vs 87%, P <0.001). Between groups, HR, mBP, CO, TSR, SV in 2 hours were similar for successful treatment. Conclusions: NPPV is benefit for patients with acute cardiogenic pulmonary edema. This may be attribute to the improvement of pulmonary function with positive pressure support. CPAP was more easily accepted than BiPAP by patients. Preload and afterload reduced with CPAP or BiPAP. When acute pulmonary edema relieved with medical treatment and NPPV, cardiac output decreased, while SV kept steady. The influence on hemodynamic parameters of CPAP and BiPAP was not different statistically.