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[急性心肌梗死患者无创正压(面罩)通气治疗]

[Using noninvasive positive pressure (mask) pulmonary ventilation in patients with acute myocardial infarction].

作者信息

Shilov A M

出版信息

Anesteziol Reanimatol. 2010 May-Jun(3):37-42.

Abstract

As of now, medical therapy for acute heart failure has achieved considerable clinical results. Nevertheless, the treatment of cardiogenic pulmonary edema (CPE) and respiratory failure remain unsolved problems, complicate the course of disease, and increase mortality among patients with acute myocardial infarction (AMI). Hospital mortality due to acute heart failure ranges from 4% and runs up to 36% in artificial ventilation-requiring situations. Noninvasive respiratory support in various modes, such as continuous positive airway pressure, pressure support ventilation (PSV), and PSV + positive end-expiratory pressure (PEEP), is an effective method for the treatment of standard medical therapy-refractory CPE in patients with AMI. Noninvasive ventilation (NV) shows clinical improvement and positive changes in the parameters of not only hemodynamics, but also gas exchange. The efficiency of various NV modes and the nature of their action on such indices, such as respiratory movement rate, heart rate, mean pulmonary artery pressure, pulmonary artery wedge pressure, peripheral tissue oxygen delivery index, pO2a, pulmonary artery pO2, and Qs/Qt, have proved similar. There is a difference in the impact of PSV and PSV+PEEP on the increase in the left ventricular stroke output index and on the reduction in arterial blood CO2 tension.

摘要

目前,急性心力衰竭的药物治疗已取得了相当可观的临床成效。然而,心源性肺水肿(CPE)和呼吸衰竭的治疗仍是尚未解决的问题,使病程复杂化,并增加急性心肌梗死(AMI)患者的死亡率。急性心力衰竭导致的医院死亡率在4%至36%之间,在需要人工通气的情况下死亡率更高。各种模式的无创呼吸支持,如持续气道正压通气、压力支持通气(PSV)以及PSV + 呼气末正压(PEEP),是治疗AMI患者中标准药物治疗难治性CPE的有效方法。无创通气(NV)不仅在血流动力学参数方面,而且在气体交换方面都显示出临床改善和积极变化。各种NV模式的效率及其对诸如呼吸频率、心率、平均肺动脉压、肺动脉楔压、外周组织氧输送指数、动脉血氧分压(pO2a)、肺动脉血氧分压、分流率(Qs/Qt)等指标的作用性质已被证明是相似的。PSV和PSV + PEEP对左心室每搏输出指数增加和动脉血二氧化碳分压降低的影响存在差异。

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