机械通气在救治危重肺源性心脏病呼吸衰竭患者中的疗效观察

Clinical efficacy of mechanical ventilation in severe chronic cor pulmonale

目的通过回顾性临床研究,探讨机械通气在救治危重肺源性心脏病(肺心病)呼吸衰竭患者中的应用价值。方法以135例临床资料完整且具有创机械通气指征的危重肺心病呼吸衰竭患者为研究对象,按治疗方法的不同,分为3组。通过比较3组患者出、入院时的血气分析(pH、PaO2、PaCO2)、血电解质(K+、Na+、Cl-)及预后指标,探讨机械通气在治疗危重肺心病呼吸衰竭患者中的临床应用价值。结果出院时3组患者pH、PaO2、PaCO2比较,有创机械通气组较无创机械通气组明显改善(P<0.05);无创机械通气组较对照组明显改善(P<0.05)。出院时3组患者好转出院率和病死率比较,结果发现机械通气可显著提高危重肺心病呼吸衰竭患者的好转出院率,降低患者的病死率(P<0.05);组间比较发现机械通气组患者的住院时间较对照组明显缩短(P<0.05),而有创与无创机械通气组之间比较差异无统计学意义(P>0.05)。结论①机械通气能迅速纠正危重肺心病患者的呼吸衰竭,改善酸碱失衡和代谢紊乱。②机械通气能缩短住院时间,提高患者好转出院率,降低病死率。③有创与无创机械通气二者不能相互取代,使用时应据患者具体情况合理选择。

Objective To explore the value of invasive and noninvasive mechanical ventilation for treatment of severe cor pulmonale in a retrospective casecontrolled study. Methods A retrospective analyses was performed in 135 patients who presented complete clinical data of respiratory failure arising from severe cor pulmonale and were eligible for mechanical ventilation. The patients were divided into three groups based on the use of ventilation, namely, the control group, non-invasive and invasive ventilation groups. We explored the value of mechanical ventilation in the treatment of severe eor pulmonale patients by comparing their blood gas tests （pH, PaO2 and PaCO2）, electrolytes and prognosis. Results At diseharge, there was a greater improvement in profiles of blood gas in those on invasive ventilation than in those on non-invasive approach （P〈0.05）, as was in those on non-invasive ventilation than in controls （P〈0.05）. Mechanical ventilation was found to be associated with improved rate of response and lower mortality at discharge （P〈0.05）. Inter-group analysis showed that mechanical ventilation markedly reduced length of hospital stay as eompared with control approach （P〈0.05）, whereas the difference was not statistically significant between invasive and non-invasive groups （P〉0.05）. Conclusion Mechanical ventilation demonstrated a rapid regression of hypoxia, carbon dioxide retention, acid-base imbalance and metabolic disorder in severe cor pulmonale. Mechanical ventilation was also shown to result in shorter length of hospital stay, higher rate of improvement at discharge and lower mortality. Invasive and noninvasive approaches in mechanical ventilation may not be proper for use on an interchangeable basis. Choice of invasive or noninvasive ventilation should be made based on specific considerations for a patient.