无创性面罩双水平气道正压通气治疗急性心肌梗死合并泵衰竭的临床观察

Clinical investigation of non-invasive ventilation in the treatment of acute myocardial infarction with heart failure

目的观察无创性面罩双水平气道正压(BiPAP)通气对急性心肌梗死合并泵衰竭患者的治疗效果,并观察治疗前后血清脑钠素(BNP)水平的变化。方法急性心肌梗死合并泵衰竭Killip分级Ⅱ～Ⅳ级患者60例,随机分为BiPAP治疗组(34例)和常规治疗组(26例)。常规治疗组给予抗血小板药物、硝酸酯类药物、强心剂和利尿剂,实施静脉溶栓、急诊冠脉内支架植入治疗等措施。BiPAP组在常规治疗基础上给予无创性BiPAP通气治疗72 h。记录入院即刻和入院24 h生命体征,进行动脉血气分析;测定入院即刻、入院24 h和72 h血清BNP水平。结果无创性BiPAP通气治疗可迅速改善患者的临床症状,24 h后与常规治疗组相比,BiPAP治疗组患者收缩压下降,心率减慢,心功能显著改善,呼吸频率下降,血气分析显示氧分压显著提高。急性心肌梗死合并泵衰竭患者的血清BNP水平显著升高,其中在发病第24 h最高,使用无创性BiPAP通气治疗24 h后血清BNP水平显著降低,72 h后降低更明显。结论对急性心肌梗死合并泵衰竭患者早期使用无创性BiPAP通气治疗,是提高抢救成功率的有效手段,血清BNP是观察泵衰竭治疗效果的敏感指标。

Objective To investigate the effects of bi-level positive airway pressure （BiPAP） ventilation in the treatment of acute myocardial infarction with heart failure and the changes of serum brain natriuretic peptide （BNP）. Methods 60 patients with acute myocardial infarction （Killip 2～4） were randomly divided into BiPAP group （n=34） and routine group （n=26）. Antiplatelet, thrombolytics, nitrate esters, cedilanid and diuretics were used in routine group. BiPAP ventilation for 72 h was applied to BiPAP group on the basis of the above treatment. The vital signs and artery gas analysis were collected at the beginning and 24 h later. The concentrations of serum BNP were also measured at the beginning and 24 h and 72 h later. Results BiPAP ventilation therapy could improve patients＇ dyspnea quickly. After 24 h treatment of BiPAP ventilation, the systolic blood pressure, heart rate, and respiratory rate decreased significantly, and partial pressure of oxygen saturation improved significantly. The level of serum BNP increased significantly in acute myocardial infarction with pump failure. BNP decreased after 24 h BiPAP ventilation treatment and further decreased after 72 h treatment. Conclusion Early use of BiPAP ventilation is a useful method in the treatment of acute myocardial infarction with pump failure, and serum BNP is a sensitive indicator of heart function.