无创机械通气治疗重症急性左心衰竭的疗效分析

Clinical observation on treatment of severe acute left heart failure with noninvasive positive pressure ventilation

目的观察无创机械通气（NPPV）治疗重症急性左心衰竭的临床效果。方法33例重症急性左心衰竭患者在常规吸氧、药物治疗的基础上，使用呼吸机予以面罩无创机械通气治疗，选择压力支持＋呼气末正压（PSV＋PEEP）通气模式。观察NPPV组与常规治疗（RT）组患者在治疗前后临床症状改善情况、心率（HR）、呼吸频率（RR）、平均动脉压（MAP）、血气分析（pH、PaO2、PaCO2、SpO2）及病死率和住院时间。结果NPPV组患者在实施机械通气2h后肺部啰音明显减少或消失。2h后复查血气分析，结果显示全部患者均有不同程度的好转。有3例患者终因心衰不能纠正而死亡。与常规治疗组及治疗前相比，NPPV组机械通气治疗后，患者呼吸困难明显改善，生命体征很快稳定，血气分析指标明显好转（P均〈0．05）。两组病死率、住院时间比较差异均有统计学意义（P〈0．05）。结论NPPV治疗重症急性左心衰竭能迅速改善患者的临床症状和低氧血症，可以提高抢救成功率，缩短住院时间，是抢救重症急性左心衰竭安全有效的辅助措施。

Objective To observe the efficiency of noninvasive positive pressure ventilation （NPPV）in the treatment of patients with severe acute left heart failure. Methods The clinical data of 61 patients with acute left heart failure from January, 2006 to May, 2008 were retrospectively analyzed. In addition to conventional treatment, 33 patients accepted NPPV by a face mask connected to a vent/lation set in pressure support ventilation （PSV）and positive end - expiratory pressure （PEEP）. The change of clinical symptoms, respiratory rate （ RR）, heat rate （ HR）, mean arterial pressure （ MAP）, arterial blood gas （ pH, PaO2, PaCO2, SpO2 ） of two groups at admission and at 2 hours, 1 day after NPPV were compared. Results After NPPV, the clinical symptoms had been improved significantly. All the clinical parameters showed a statistical differences （ P all 〈 0. 05 ） compared with those before NPPV and the routine treatment（RT） group. The mortality was remarkably lower in the NPPV group（9.09% ） than that in the RT group（28.57% ） （P 〈0. 05）. The mean length of hospital stay was significantly shorter in the NPPV group than that in the RT group （P 〈 0. 05）. Conclusion NPPV can improve symptoms and hypoxemia in patients with the se- vere acute left heart failure rapidly. It is a safe and effective method in treating the severe acute left heart failure.