无创正压通气对慢性充血性心力衰竭加重期治疗作用的初步研究

Preliminary study on noninvasive positive pressure ventilation in patients with exacerbation of chronic congestive heart failure

目的观察无创正压通气(NPPV)对慢性充血性心力衰竭(CHF)加重期患者的血流动力学和氧动力学的影响,探讨NPPV治疗CHF的机制。方法应用自身前后对照方法观察持续气道正压通气(CPAP)对8例CHF加重期患者的治疗作用,所有患者均经面罩接BiPAP Vi-sion呼吸机,采用CPAP进行治疗。CPAP的压力水平设定为5 cm H2O,观察时间为2 h,动态观察在CPAP治疗前30 min、1 h、2 h和停用CPAP治疗后1 h的血流动力学及氧动力学变化。心排出量用热稀释法测定。结果CPAP治疗1 h和2 h的心排出量、每搏输出量(SV)和氧输送(.DO2)均较CPAP治疗前显著增加(P<0.05)。CPAP的治疗效应在治疗时间内基本保持稳定。停用CPAP治疗1 h后,上述指标又下降到CPAP治疗前水平。肺毛细血管嵌顿压(PCWP)、pH、Pa-CO2、PaO2和氧耗量(.VO2)无明显变化(P>0.05)。线性相关分析显示各时相D.性相关(P<0.05)。结论CHF加重期患者应用CPAP可改善左心功能,增加心排出。CHF加重期患者存在组织水平缺氧,CPAP治疗可通过增加D.O,改善组织氧供。

Objective To observe the hemodynamic and oxygen dynamie effects of noninvasive positive pressure ventilation（NPPV） in patients with exacerbation of chronic congestive heart failure（CHF）. Methods The effects of continuous positive airway pressure（CPAP） in eight consecutive patients with CHF exacerbation were observed before and after ventilation. All the eight patients were connected to BiPAP Vision ventilator via face mask. CPAP was set at the level of 5 cm H2O, the changes of respiratory mechanics, oxygen dynamics and hemodynamics were measured at 30 rain before（baseline）, 1 hour and 2 hours after CPAP, and 1 hour after ventilation weaning. Cardiac output was measured by thermodilution technique. Results Compared with baseline, cardiac output, stroke volume（SV） and oxygen delivery（ Do2 ）were increased significantly（ P 〈 0.05）. The effects remained stable and an severe side effects were observed during CPAP treatment. All the parameters above mentioned returned to the baseline when CPAP was discontinued for 1 hour. Pulmonary capillary wedge pressure （PCWP）, pH, arterial partial pressure of carben dioxide （ PaCO2 ）, arterial partial pressure of oxygen （ PaO2 ） and oxygen consumption（Vo2 ）had no significant changes after CPAP ventilation（ P 〉 0.05）. Correlation analysis showed that there were linear e.orrelations between Do2 and Vo2 at each time point （ P 〈 0.05 ）. Conclusions CPAP can improve the left ventricular funetion of patients with CHF exacerbation and lead to increase in cardiac output,thereafter lead to increase in Do2, and alleviate tissue anoxia in the patients with exacerbation of CHF.