| 摘要: |
| ［摘要］ 目的 评价有创-无创序贯性机械通气治疗重症急性心源性肺水肿患者的疗效。方法 选32例重症急性心源性肺水肿患者随机分为两组，序贯治疗组16例，在常规治疗的基础上，以同步间歇指令通气+压力支持通气（SIMV+PSV）方式行机械通气，待出现“肺水肿控制窗”后拔除气管插管，改为双水平气道正压（BiPAP）支持通气并撤机；对照组16例以SIMV+PSV方式撤机。检测上双水平正压（BiPAP）呼吸机前及2 h后的动脉血气，对照分析两组病例的死亡例数、发生VAP例数、重新插管例数，有创机械通气时间和总的机械通气时间。结果 序贯治疗组患者拔管前及拔管2 h后生命体征及血气分析比较差异无统计学意义（P>0.05）；撤机后序贯治疗组死亡例数、发生VAP例数、重新插管例数及有创机械通气时间和总机械通气时间均少于对照组（P均<0.05）。结论 有创-无创序贯性机械通气治疗重症急性心源性肺水肿较单纯的有创机械通气具有更安全可靠的效果。 |
| 关键词: 机械通气 急性心源性肺水肿 血气监测 治疗 |
| DOI：10.3969/j.issn.1674-3806.2011.11.11 |
| 分类号:R 541.6 |
| 基金项目: |
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| Clinical evaluation of sequential non-invasive following invasive mechanical ventilation for severe acute cardiogenic pulmonary edema |
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ZHAO Kai-liang, YANG Xin-jiang
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Department of Emergency，Qinzhou Second People′s Hospitol，Guangxi 535000，China
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| Abstract: |
| ［Abstract］ Objective To evaluate the effect of sequential non-invasive following invasive mechanical ventilation for severe acute cardiogenic pulmonary edema. Methods Thirty-two patients with severe acute cardiogenic pulmonary edema were randomly divided into two groups with 16 patients in each group. All patients received routine drug therapy and endotracheal intubation. Sixteen patients in sequential therapy group were ventilated by synchronized intermittent mandatory ventilation + pressure support ventilation (SIMV+PSV) mode mechanical ventilation. The endotrachenl intubation was removed after a pulmonary edema control window appeared and changed to two-level positive airway pressure(BiPAP) support ventilation and weaned from mechanical ventilation. The control group was weaned from mechanical ventilation by SIMV+PSV means. The parameters of hemodynamics, oxygendynamics were measureed during invasive mechanical ventilation, two hours after oxygen therapy, after non- invasive mechanical ventilation. The number of death patients, the number of patients of VAP, the number of patients of re-intubation, time of invasive mechanical ventilation and time of general ventilation time were compared between two group. Results There were no significant difference in respiratory and circulatory parameters after treatment in BiPAP group(P>0.05). The number of patients of VAP, the number of patients of re-intubation, the time of invasive mechanical ventilation and time of total duration of mechanical ventilation in sequential therapy group were less than those in the control group (P<0.05). Conclusion Sequential non-invasive following invasive mechanical ventilation for severe acute cardiogenic pulmonary edema have more secure and reliable results compared with invasive mechanical ventilation alone. |
| Key words: Mechanical ventilation Acute cardiogenic pulmonary edema Blood gas monitoring Treatment |
