血管外肺水指数指导双水平气道正压通气治疗HFrEF患者的临床疗效

EVLWI guided bilevel airway positive pressure ventilation in the treatment of HFrEF patients

目的探讨以脉搏轮廓心输出量监测技术(PICCO)筛选使用双水平气道正压通气(BiPAP)治疗射血分数降低型心力衰竭(HFrEF)患者的临床疗效。方法纳入2017年1月~2020年12月新疆维吾尔自治区人民医院收治的HFrEF患者358例,具备无创呼吸机辅助通气(NIPPV)患者208例,其中具有PICCO监测适应症且签署知情同意146例,测得基线资料;采用随机数字化原则分为两组:BiPAP组(n=74)和面罩吸氧组(n=72),比较干预后4 h的PICCO相关指标及转机械通气治疗的百分比。依据血管外肺水指数(EVLWI)结果,EVLWI≥10为BiPAP干预组39例(PICCO+BiPAP),面罩吸氧30例(PICCO+面罩吸氧);分别于0(基线)、4、8、12、24 h共5次测得PICCO数据。统计分析各组BNP变化、血气、CI前后、EVLWI、ITBVI前后变化。统计分析院内心源性死亡、恶性心律失常、心源性休克发生率、无创改有创插管转换率。结果①与面罩吸氧组相比,BiPAP组转机械通气概率更低,在4 h时氧分压恢复更快,EVLWI降低(均P<0.05)。②以EVLWI≥10为界限,BiPAP辅助EVLWI≥10患者临床效果更明显,不同时间点LnBNP逐渐降低、心脏指数增加、胸腔内血容积指数降低(P<0.01);而在EVLWI<10组中上述指标无统计学差异(P>0.05)。③在EVLWI≥10的HF患者中,与面罩吸氧相比,BiPAP救治效果更明显,转机械通气低、心脏脂数增加(P<0.01)。结论BiPAP模式对EVLWI≥10患者辅助通气有益于HFrEF降低BNP、增加心脏指数,减少有创机械通气,提高抢救成功率。

Objective To investigate the clinical efficacy of BiPAP in the treatment of heart failure with reduced ejection fraction(HFrEF)by pulse induce contour cardiac output(PICCO)monitoring technology.Methods A total of 358 HFrEF patients admitted to The People's Hospital of Xinjiang Uygur Autonomous Region from January 2017 to December 2020 were included.There were 208 patients with non-invasive ventilators assisted ventilation(NIPPV),among whom 146 patients had PICCO monitoring indications and signed informed consent.The parameters were divided into BiPAP group(n=74)and Mask oxygen group(n=72)by random digitalization.Pressume PICCO coefficient and percentage of mechanical ventilation were compared at 4 h after intervention.Referring to EVLWI,we presume that 39 cases were found with COEFFICIENT(PICCO+BiPAP)in BiPAP intervention group,and 30 cases were found with mask oxygen inhalation(PICCO+mask oxygen inhalation).PICCO data were measured at 0(baseline),4,8,12 and 24 h,respectively.The changes of BNP,blood gas,CI,EVLWI and ITBVI in each group were statistically analyzed.The incidence of cardiogenic death,malignant arrhythmia,cardiogenic shock and the conversion rate of non-invasive intubation were analyzed.Results Compared with mask oxygen intake group,BiPAP group had a lower probability of mechanical ventilation,oxygen partial pressure recovered faster at 4 h,and EVLWI decreased(allP<0.05).Taking EVLWI≥10 as the limit,we presume that BiPAP assisted EVLWI patients had more obvious clinical effect,and presume that BiPAP assisted EVLWI patients gradually decreased,cardiac index increased,and intrathoracic blood volume index decreased(P<0.01).We presume that there was no statistical difference between THE above-mentioned indexes in EVLWI<10 groups(P>0.05).In HF patients with EVLWI≥10,compared with mask oxygen intake,BiPAP therapy was more effective,and mechanical ventilation was lower and cardiac lipid number increased(P<0.1).Conclusion BiPAP mode is beneficial for patients with EVLWI≥10 to assist ventilation,reduce BNP,increase CI,reduce invasive mechanical ventilation and improve the success rate of rescue.