Establishment of noninvasive artificial ventilation in patients with sever lung edema

1.研究一：30例重度心源性肺水肿致呼吸衰竭患者随机分为两组：氧疗+经鼻持续气道正压通气组（CPAP组）和单纯面罩吸氧组（吸氧组）。CPAP组心率和平均肺动脉压明显下降。CPAP组6 h后PaO 2/FiO 2比值升高（163±70 ~ 332±104，p<0.01），血浆ET-1浓度与平均肺动脉压、PaO 2/FiO 2呈显著相关。（研究2）将22例患者随机分为两组：CPAP组（鼻罩吸氧+CPAP）和吸氧组（面罩吸氧）。CPAP组2例患者（18%）和氧气组8例患者（73%）需要气管插管机械通气（p=0.03）。日 ...更多信息 CPAP组的住院死亡率（9%）显著低于吸氧组（64%，p=0.02）。CPAP组肺动脉楔压、平均肺动脉压、心率均明显下降。插管组PaO 2/FiO 2比值显著升高。CPAP组动脉血浆内皮素-1浓度较氧疗组下降更早（p<0.05）。经鼻持续气道正压通气可早期改善氧合和血流动力学，降低死亡率。对于肺水肿患者，建议早期进行积极的呼吸管理.负压通气（外部高频振荡）（研究1）7例上腹部手术后高碳酸血症患者接受EHFO通气。PaCO 2明显下降。PaO 2明显升高。FEV 1和FVC显著增加。EHFO是一种有效的气体交换方法，与早期恢复术前肺功能相关。研究2：12例患者采用EHFO联合PSV通气。心脏指数和每搏输出量指数显著增加，而肺动脉楔压无变化。PaO 2/FiO 2和PaCO 2。建立EHFO后，整个肺野的呼吸音可能很硬。作为急性呼吸衰竭患者的一种通气方法，EHFO联合PSV在促进分泌物引流时可能比传统机械通气具有潜在优势。EHFO的有益效果可能在几小时后出现。少

1. Positive pressure ventilation (Nasal continuous positive airway pressure)(Study 1) Thirty patients with respiratory failure due to severe cardiogenic puylmonary edema were assigned to two groups : received oxygen plus nasal CPAP (CPAP group), and received only oxygen by face mask (oxygen group). The heart rate and the mean pulmonary artery pressure decreased significantly in the CPAP group. The PaO2/FiO2 ratio increased in the CPAP group (163±70 to 332±104, p<0.01) after 6 hr. There was a significant correlation between the arterial plasma ET-1 concentrations and mean pulmonary artery pressure, and Pao2/FIo2.(Study 2) Tenty-two consecutive patients were assigned at random to either of the following two groups : received oxygen plus CPAP delivered by a nasal mask (CPAP group), and received only oxygen through face mask (oxygen group). Two patients (18%) in the CPAP group and 8 patients (73%) in the oxygen group required mechanical ventilation with endotracheal intubation (p=0.03). Th … More e hospital mortality rate in the CPAP group (9%) was significantly lower than the oxygen group (64%, p=0.02). The pulmonary artery wedge pressure, mean pulmonary artery pressure, and heart rate significantly decreased in the CPAP. The PaO2/FiO2 ratio significantly increased in the intubation group. Arterial plasma endothelin-1 concentrations decreased significantly earlier in the CPAP group than in the oxygen group (p<0.05). Nasal CPAP lead to an early improvement in oxygenation and hemodynamics, and decreased the mortality rate. Early and active respiratory management is recommended in patients with pulmonary edema.2. Negative pressure ventilation (External high-frequency oscillation)(Study 1) Seven patients with postoperative hypercapnia following upper abdominal surgery were ventilated with EHFO. PaCO2 significantly decreased. PaO2 significantly increased. The FEV1 and FVC significantly increased. EHFO is an effective method of gas exchange which is associated with earlier return to preoperative lung function.(Study 2) Twelve patients were ventilated with EHFO combined with PSV. Significant increases were noted in cardiac index and stroke volume index without changes in pulmonary artery wedge pressure. PaO2/FiO2 and PaCO2. Breath sounds could be hard well throughout the lung fields after institution of EHFO. As a method of ventilation for patients with acute respiratory failure, EHFO combined with PSV may have potential advantages over conventional mechanical ventilation when drainage of secretions is facilitated. Beneficial effects of EHFO may appear after several hours. Less