双水平正压无创通气治疗急性左心衰并发呼吸衰竭的临床研究

Clinical Observation of Non-invasive Mechanical Ventilation Via Facial Mask to Treat the Acute Left Ventricular Failure Associating with Respiratory Failure

目的:观察双水平正压无创通气(BiPAP)治疗急性左心衰并发呼吸衰竭的临床效果。方法:随机将急性左心衰患者30例分为采用无创通气和有创通气治疗的两组,记录治疗前后呼吸力学、血流动力学及血气分析各参数。结果:无创通气组治疗1h后,pHa(7.42±0.048)显著高于治疗前(7.29±0.018),Lac(2.72±0.76mmol/L)显著低于治疗前(3.98±1.04 mmol/L),PaO_2(80.6±10.3 mm Hg)显著高于治疗前(47.5±6.28 mm Hg),PaCO_2(37.8±3.63 mm Hg)显著低于治疗前(50.3±5.74 mm Hg),HR(108.3±8.9次/min)显著低于治疗前(128.2±12.3次/min),MAP(97.31±2.62 mm Hg)显著低于治疗前(105.85±5.79 mmHg)(P均<0.01),并且持续通气4 h和24 h后,部分指标仍继续好转。无创通气组和有创通气组PaO_2、pHa、PaCO_2、Lac治疗前和治疗4 h前后差异均无显著性(P均>0.05)。结论:针对不同诱因引起急性左心衰并发呼吸衰竭的患者,在内科治疗的基础上,果断地使用BiPAP治疗,能通过增加氧供,使患者低氧症状迅速缓解,效果与有创通气无差异,还可避免气管插管,减少呼吸机相关性肺损伤,并发症减少,死亡率降低,有效提高了急诊的抢救能力。

Objective: To evaluate the clinical value of non-invasive mechanical ventilation via facial mask ( BiPAP) to treat left ventricular failure associating with respiratory failure. Methods; All patients were randomly divided according to use BiPAP or not. Data included respiratory function hemodynamic information and blood gas analysis before and after treatment. Results: one hour alter treatment,the pHa value of artery increased from 7. 29 ±0. 018 mmol/L to 7. 42 ±0. 048 mmol/L,lactic acid decreased from 3. 98 ± 1. 04 mmol/L to 2. 72 ±0. 76 mmol/L, PaO_2 increased from 47. 5 ±6. 28 mm Hg to 80. 6 ± 10. 3 mm Hg,PaCO_2 decreased from 50. 3 ±5. 74 mm Hg to 37. 8 ± 3. 63 mm Hg HR decreased from 128 ± 12. 3 bpm to 108. 3 ±8. 9 bpm,MAP deereaset from 105. 85 ±5. 79 mm Hg lo 97. 31 ±2. 62 mm Hg ( P <0. 01). All these changes remained better 4 hours and even 24 hours during BiPAP therapy. There was no significant difference of PaO_2 , pHa, PaCO_2 , lactic acid before and after treatment two groups ( P > 0. 05 ). Conclusion: According to various etiology of acute left ventricular failure, based on usual medical therapy, BiPAP could increase oxygen delivery rapidly to avoid ventilator lung injury including infection, intratrachea ventilation. Which could be decreased in emergency.