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目的探讨应用经面罩双水平正压通气(BiPAP)治疗急性心源性肺水肿(ACPE)的临床价值。方法回顾性分析20例心功能Ⅳ级的ACPE患者,在常规药物治疗效果不佳的情况下,使用经面罩BiPAP治疗,比较BiPAP治疗前及治疗后2h,患者的心功能分级、平均动脉压(MAP)、心率(HR)、呼吸频率(RR)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)改善情况。结果20例患者中18例心功能分级明显改善。由心功能IV级转变为心功能Ⅲ级6例,心功能Ⅱ级12例,2例无效患者及时改行气管插管。经面罩BiPAP治疗2h后患者的MAP、HR、RR、PaO2均有明显改善,差异有统计学意义(P<0.01)。未发生与正压通气相关的严重并发症。结论对于常规药物治疗效果不佳的ACPE患者,只要符合无创机械通气的基本要求,使用经面罩BiPAP治疗,具有安全、无创、有效的优点,可作为ACPE的一线治疗方法。
Objective To investigate the clinical value of double positive airway pressure (BiPAP) in the treatment of acute cardiogenic pulmonary edema (ACPE). Methods A retrospective analysis of 20 cases of ACPE patients with grade IV heart function was performed with BiPAP mask before and after treatment for 2 hours. The patients were divided into two groups: heart function grading, mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR), PaO2 and PaCO2. Results The cardiac function of 18 of 20 patients was significantly improved. From grade IV of heart function to grade Ⅲ of cardiac function in 6 cases, grade Ⅱ of cardiac function in 12 cases, 2 cases of ineffective patients changed to tracheal intubation in time. MAP, HR, RR and PaO2 in patients treated with mask BiPAP were significantly improved after 2 hours (P <0.01). No serious complications related to positive pressure ventilation occurred. CONCLUSION: ACPE patients with poor response to conventional medical therapy may be the first-line treatment for ACPE as long as they meet the basic requirements of noninvasive mechanical ventilation and are safe, noninvasive and effective when treated with mask BiPAP.