有创呼吸机实施无创正压通气治疗急性心源性肺水肿与常规吸氧比较分析

目的 比较分析有创呼吸机实施无创正压通气与常规吸氧治疗急性心源性肺水肿的疗效.方法 选择2012年1月至2013年12月无锡市解放军101医院收治的急性心源性肺水肿患者88例,随机分为观察组与对照组,各44例.两组均予常规抗心力衰竭治疗.观察组予有创呼吸机实施无创正压通气治疗,对照组予以常规吸氧治疗,比较其治疗效果.结果 观察组有创呼吸机实施无创正压通气治疗1h后,酸碱度（pH）（7.12±0.18比7.38±0.11,t=4.568）、动脉血二氧化碳分压（PaCO2）（43.10±15.22）mm Hg比（26.20±10.15）mm Hg,t=14.254]、氧合指数（PaO2/FiO2）（123.4±32.5比234.4±28.6,t=24.241）、血氧饱和度（SaO2）（71.20±8.42）％比（89.70±9.94）％,t=11.248]、呼吸频率（RR）（36.2±7.2）次/min比（21.5±4.2）次/min,t=9.359]、心率（HR）（128.1±19.2）次/min比（101.3±11.8）次/min,t=2.348]等各项指标明显改善,差异具有统计学意义（P＜0.05）.治疗1h后,两组pH（7.38±0.11比7.20±0.21,t=6.345）、动脉血PaCO2（26.20± 10.15）mm Hg比（32.2±11.15）mmHg,t=11.459]、PaO2/FiO2（234.4±28.6比172.3±31.6,t=18.189）、SaO2（89.70±9.94）％比（82.10±10.64）％,t=9.635]、RR（21.5±4.2）次/min比（28.7±6.8）次/min,t=8.259]、HR（101.3±11.8）次/min比（112.7±13.7）次/min,t=3456]等各项指标分别相比较,差异均具有统计学意义（P＜0.05）.观察组治疗有效率为88.6％,显著高于对照组的63.6％（x2=7.568,P=0.006）;气管插管率分别为9.09％、25.0％,观察组显著低于对照组（x2=3.938,P=0.043）;死亡率分别为4.54％、6.82％,差异无统计学意义（x2=0.212,P=0.500）.结论 有创呼吸机实施无创正压通气与常规吸氧治疗相比较,能够提高治疗成功率,降低气管插管率,值得在临床进一步推广应用.

Comparative study of noninvasive mechanical ventilation and ordinary oxygen therapy in acute cardiogenic pulmonary edema patients

Objective To investigate the effect of noninvasive positive pressure mechanical ventilation by invasive ventilator and ordinary oxygen therapy in acute cardiogenic pulmonary edema patients. Methods 88 eases of acute cardiogenic pulmonary edema were recruited and divided randomly into two groups as the observation group and the control. The observation group accepted noninvasive positive pressure mechanical ventilation by invasive ventilator beside regular anti-heart-failure therapy, while the control group accepted ordinary oxygen therapy. The vital signs and therapeutic effect were analyzed. Results Compared to the control, vital sign indexes including pH （7.38±0.11 vs 7.20±0.21, t=6.345）, PaCO2 （26.20±10.15）mm Hg vs （32.20±11.15）mm Hg, t= 11.459], PaO2/FiO2 （234.4±28.6 vs 172.3±31.6, t=18.189）, SaO2 （89.70±9.94）% vs （82.10±10.64）%, t= 9.635], RR（21.5±4.2） vs （28.7±6.8）, t=8.2593, HR（101.3±11.8） vs （112.7±13.7）, t=3.456] of the observation group were improved significantly （P〈0.05） after lh therapy. Observation treatment group has effective rate of 88.6% （ 39/44 ）, which was significant higher than the control group 63.6% （28/44） （χ2=7.568, P=0.006 ）. Endotracheal intubation rates were 9.09% （4/44）, which was much lower than the control group 25.0% （11/44）（χ2= 3.938,P=0.043）. The mortality rate for observation group was 4.54%（2/44）, and there was no significant difference from the control group 6.82%（3/44）（χ2=0.212,P=0.500）. Conclusion Noninvasive positive pressure mechanical ventilation by invasive ventilator in acute cardiogenic pulmonary edema patients can relieve symptoms and hypocemia effectively, decrease endotracheal intubation rate, which deserves further clinical application.