双水平正压无创通气治疗急性左心衰竭

Bi-level Positive-Pressure Non-invasive Ventilation on Treatment of Acute Left Ventricular Failure

目的评价双水平正压无创通气(b i-level positive-pressure non-invasive ventilation,B i-level)治疗急性左心衰竭(ALVF)的临床疗效。方法ALVF患者30例,随机分为B i-level治疗组和对照组(常规药物治疗),各15例。观察两组患者治疗前、治疗后2 h和24 h心率、呼吸、血压以及血气分析的变化,同时监测B i-level治疗组无创通气24 h前、后心功能指标,并比较两组患者治疗总有效率、APACHEⅡ评分情况和平均住院天数。结果B i-level治疗组无创通气24 h后的心率和呼吸明显减慢(P<0.01),呼吸困难均改善,心功能均有进步,总有效率100%,通气24 h后PaO2和SaO2显著升高(P<0.05)。对照组在相应治疗时间内总有效率为73.33%。两组治疗前后APACHEⅡ评分和平均住院天数也有明显差异(P<0.05)。结论B i-level治疗ALVF能够及时缓解症状,改善心肺功能。

Objective To observe the therapeutic efficacy of bi-level positive-pressure non-invasive ventilation on the treatment of acute left ventricular failure （ALVF）. Methods Thirty patients with ALVF were randomized to a control group and a treatment group. In addition to conventional therapy, the treatment group were treated with bilevel positive-pressure ventilation. The changes of clinical symptoms and arterial blood gases were measured. The APACHE Ⅱ scores and hospital stays were analyzed, and the hemodynamic parameters such as cardiac output （CO） , cardiac index（CI）, stroke volume（SV） and systemic vascular resistance （SVR） were detected before and after ventilation. Results The treatment group showed more significant improvement in clinical symptoms, APACHE Ⅱ scoring, and fewer hospital stays compared with the control group（ P 〈 0.05）. After ventilation, PaO2, SaO2 were elevated significantly（P 〈0.05）. CO, CI and SV increased significantly while SVR and heart rate decreased（P 〈0.05）. Conclusion Bi-level positive-pressure non-invasive ventilation is capable to improve dyspnea and relieve clinical symptoms of ALVF.