探讨应用BiPAP通气治疗老年慢性肺心病患者合并急性左心衰竭的临床作用

Clinical of Bileve Positive Airway Pressure Ventilation in Senile Chronic Pulmonary heart Disease complicated with Acute Left Ventricular Failure

目的研究临床应用双水平气道正压（BiPAP）通气治疗老年慢性肺心病患者合并急性左心衰竭的作用。方法将52例患有慢性肺心病合并急性左心衰竭的老年患者随机分为两组,对照组26例,采用常规治疗;治疗组26例,在常规治疗的基础上给予BiPAP经面（鼻）罩机械通气治疗,观察分析动脉血气、呼吸频率、心率、血压、心脏功能。结果治疗组pH、SaO2、PaCO2、HR、RR等在治疗1h后较治疗前均有明显改善,治疗组治疗后3h的改善明显优于对照组（P〈0.01）;在纠正低PaO2方面,治疗组早期即表现出优越性（P〈0.05）。3d后治疗组总有效率95.2%,而对照组为72.7%,两组疗效有显著性差异（P〈0.05）。结论BiPAP经面（鼻）罩机械通气治疗能够改善老年慢性肺心病合并急性左心衰竭患者的通气血流比例失调,缓解呼吸肌疲劳,减轻心脏负荷,改善心脏功能,纠正低氧血症和高碳酸血症。

Objective To evaluate the therapeutic effect of bileve postive airway pressure （BiPAP） on acute left ventricular failure secondary to chronic pulmonary heart disease. Methods 52 patients with acute left ventricular failure caused by chronic pulmonary heart disease were randomly divided into two groups. 26 patients in control group were treated by routine therapy ; 26 patients intreatment group, based on routine therapy were treated by BiPAP . The blood gas analysis, respiratory rates, heart rates, blood pressure and heart failure classification were monitored and analyzed. Results The PH, SaO2, PaCO2 , HR, RR, RR in treatment group were significantly improved after one-hour＇s treatment, as compared with those before treatment. The improvement in treatment group after 3-hour＇s treatment was superior to that of control （P〈0.01）. The effect of improving low PaO2 in treatment group at early period was also superior to that of control （P〈0.05）. blood pressure was significant changed after treatment but there was no significant difference between two groups. After 3 days was 96.1%,however ,which was 72.7% in contral group. There was a significant difference between two groups（P〈0. 05）. Conclusion BiPAP could improve ventilation/perfusion mismatch and relieve the respiratory muscle fatigue in patients with acute left ventricular failure caused by chronic pulmonary heart disease, lt could improve cardiac function, pulmonary edema and hypoxemia more hypoxemia more rapidly than routine therapy.