Kinoshita Masaki, Okayama Hideki, Kawamura Go, Shigematsu Tatsuya, Takahashi Tatsunori, Kawata Yoshitaka, Hiasa Go, Yamada Tadakatsu, Kazatani Yukio
Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
Department of Cardiology, Ehime Prefectural Central Hospital, Ehime, Japan.
J Cardiol. 2017 Jan;69(1):308-313. doi: 10.1016/j.jjcc.2016.05.015. Epub 2016 Jun 29.
Adaptive servo-ventilation (ASV) at home has been used for patients with chronic heart failure. However, its effect on acute cardiogenic pulmonary edema (ACPE) is not clear. The aim of this study was to elucidate the effect of ASV use in the emergency room in patients with ACPE.
We enrolled 198 consecutive patients with ACPE. Eighty patients received standard therapies, such as oxygen inhalation and vasodilators (conventional therapy group), and 118 received ASV in addition to standard therapy (ASV therapy group). ASV was initiated in the emergency room immediately after diagnosis. The procedure was switched over from ASV to endotracheal intubation (ETI) when oxygenation was insufficient.
The ETI rate in the ASV therapy group was significantly lower than that in the conventional therapy group (3% vs. 21%, p<0.01). The intensive care unit and/or high care unit length of stay in the ASV therapy group was also significantly shorter than that in the conventional therapy group (1.9±2.1 days vs. 5.3±6.8 days, p<0.01). Consequently, the hospitalization period in the ASV therapy group was shorter than that in the conventional therapy group (19.3±11.0 days vs. 26.3±16.6 days, p<0.01).
In patients with ACPE, rapid introduction of ASV in the emergency room reduces the need for ETI and decreases the hospitalization period.
家庭适应性伺服通气（ASV）已用于慢性心力衰竭患者。然而，其对急性心源性肺水肿（ACPE）的影响尚不清楚。本研究的目的是阐明在急诊室对ACPE患者使用ASV的效果。
我们连续纳入了198例ACPE患者。80例患者接受标准治疗，如吸氧和血管扩张剂（传统治疗组），118例患者除标准治疗外还接受ASV（ASV治疗组）。诊断后立即在急诊室启动ASV。当氧合不足时，将程序从ASV转换为气管插管（ETI）。
ASV治疗组的ETI率显著低于传统治疗组（3%对21%，p<0.01）。ASV治疗组在重症监护病房和/或高级护理病房的住院时间也显著短于传统治疗组（1.9±2.1天对5.3±6.8天，p<0.01）。因此，ASV治疗组的住院时间短于传统治疗组（19.3±11.0天对26.3±16.6天，p<0.01）。
对于ACPE患者，在急诊室快速引入ASV可减少ETI的需求并缩短住院时间。
