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目的探讨无创正压通气在急性心源性肺水肿治疗中的应用时机。方法 42例急性心源性肺水肿患者随机分为对照组22例与干预组20例。对照组给予镇静、利尿、强心、扩张支气管、吸氧等常规治疗15min后行双水平气道正压(bi-level positive airway pressure,BiPAP)治疗。干预组先给予BiPAP治疗,15min后给予镇静、利尿、强心、扩张支气管、吸氧等常规治疗。观察2组治疗前、治疗第2,24h时心率、呼吸频率、平均动脉压(mean arterial pressure,MAP)、pa(O2)、pa(CO2),并比较2组治疗过程中插管率、病死率及住院时间。结论 BiPAP治疗2h后,对照组17例,干预组18例发绀及呼吸困难好转,肺部啰音减少。2组治疗第2,24h心率、呼吸频率、MAP、pa(O2)、pa(CO2)水平均较治疗前改善(P<0.05),2组治疗24h各项指标比较差异无统计学意义(P>0.05)。2组插管率、病死率比较差异有统计学意义(P<0.05),住院时间比较差异无统计学意义(P>0.05)。结论对急性心源性肺水肿患者尽早实施BiPAP治疗,可降低插管率和病死率。
Objective To investigate the timing of noninvasive positive pressure ventilation in the treatment of acute cardiogenic pulmonary edema. Methods A total of 42 patients with acute cardiogenic pulmonary edema were randomly divided into control group (n = 22) and intervention group (n = 20). The control group was treated with bi-level positive airway pressure (BiPAP) after 15 minutes of routine therapy such as sedation, diuretic, cardiac, bronchial expansion, and oxygenation. Intervention group given BiPAP treatment, 15min after sedation, diuretic, cardiac, bronchial expansion, oxygen and other conventional treatment. The heart rate, respiratory rate, mean arterial pressure (MAP), pa (O2), pa (CO2) at 2 and 24 hours before treatment were observed in two groups before treatment, and the intubation rate, Rate and length of stay. Conclusions After 2 hours of BiPAP treatment, 17 cases in the control group, cyanosis and dyspnea in the intervention group improved, and pulmonary rales decreased. The heart rate, respiration rate, MAP, pa (O2) and pa (CO2) in group 2 and group 2 were both improved than those before treatment (P <0.05). There was no significant difference between the two groups > 0.05). There were significant differences in intubation rate and mortality among the two groups (P <0.05) and no significant differences in hospitalization time (P> 0.05). Conclusions BiPAP treatment of acute cardiogenic pulmonary edema as soon as possible can reduce the intubation rate and mortality.