双水平气道正压通气BiPAP与心源性肺水肿

Intended Use

The Synchrony is intended to provide non-invasive ventilation in adult patients (>30 kg) for the treatment of respiratory insufficiency (a condition in which the patient can maintain ventilation without mechanical support for some period of time) or obstructive sleep apnea. This device may be used in the hospital or home. The Synchrony is intended for use with nasal masks and full-face masks as recommended by Respironics.

Contraindications

The Synchrony should not be used if you have severe respiratory failure without a spontaneous respiratory drive. If any of the following conditions apply to you, consult your physician before using the Synchrony ventilator:

• inability to maintain a patent airway or adequately clear secretions.

• at risk for aspiration of gastric contents.

• diagnosed with acute sinusitis or otitis media.

• allergic or hypersensitive to the mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance.

• epistaxis, causing pulmonary aspiration of blood.

• hypotension.

Precautions

Immediately report any unusual chest discomfort, shortness of breath, or severe headace to your physician. If skin irritation or breakdown develops from the mask, refer to the mask instructions for appropriate action.

The following are potential side effects of noninvasive positive pressure therapy:

• ear discomfort

• conjunctivitis

• skin abrasions due to noninvasive interfaces

• gastric distention (aerophagia)

无创正压通气临床应用中的几点建议：

中华医学会呼吸病学分会临床呼吸生理及ICU学组

充血性心力衰竭合并呼吸衰竭患者对NIPPV（无创正压通气）有良好反应，有助于心功能改善。可能的机制是：（1）NIPPV的正压通气作用减少回心血量，从而减轻心脏前负荷；（2）正压通气作用减小心室跨壁压；（3）NIPPV 使氧合改善，心肌供氧增加；（4）对存在心源性肺水肿患者，正压通气有助于减轻肺泡水肿。

推荐意见：

NPPV可改善心源性肺水肿患者的气促症状，改善心功能，降低气管插管率和病死率（A级）。首选CPAP（持续正压通气），而BiPAP（双水平气道正压通气）可应用于CPAP治疗失败和PaCO2>45mmHg的患者。目前多数研究结果认为BiPAP不增加心肌梗死的风险，但对于急性冠脉综合征合并心力衰竭患者仍应慎用BiPAP。