无创通气治疗难治性心力衰竭时间观察窗的选择

The choice of the time-observed-window with noninvasive positive pressure ventilation in the treatment of the patients with severe heart failure

目的探讨无创正压通气(Noninvasive Positive Pressure Ventilation,NIPPV)用于难治性心力衰竭患者治疗的时间观察窗选择。方法2004年至2008年期间符合难治性心力衰竭诊断标准的37例患者均接受NIPPV(IPAP8～20cmH2O、EP-AP2～10cmH2O),依患者情况逐渐调整参数;如出现病情恶化随时改为有创通气治疗。结果37例患者中29例于NIPPV治疗2h内症状及各项指标均有不同程度的改善,8例最终改为有创通气治疗。结论1、呼吸窘迫及氧合状况的改善成为NIPPV治疗有效的重要指标;2、治疗2小时可以作为判断患者对NIPPV治疗是否有效的时间窗;3、NIPPV治疗期间需要严密监测病情变化,避免并发症。

Objective To study the Time-Observed-Window of the patients with severe heart failure during the treatment of Noninvasive Positive Pressure Ventilation （NIPPV）. Methods 37 patients with severe heart failure accepted NIPPV （ IPAP 8 - 20 cm H2 O, EPAP 2 - 10 cm H2 O）, the clinical feature were recorded during the therapy. If the condition got worse, invasive ventilation was offered immediately. Results 29 patients＇conditions improved within 2 hours in different degrees. 8 patients used NIPPV after initial treatment therapy. 3 patients were not intolerable, 5 patients＇conditions got worse. Conclusion 1 ,The improvement of dyspnea and oxygenation may be important during NIPPV. 2 ,The Time-Observed-Window may be defined as the patients, response to NIPPV with 2 hours. 3 ,The patients should be monitored during the therapy in order to avoid complication.