双水平正压通气与重组脑钠肽治疗急性左心力衰竭临床疗效对照研究

Clinical Study of Noninvasive Bi-level Positive Airway Pressure Ventilation and rhBNP in the Treatment effect of Acute Left Heart Failure

目的观察无创双水平正压通气(BiPAP)与rhBNP治疗急性左心力衰竭在短期内的临床疗效。方法随机选取52例急性左心力衰竭患者分为两组:BiPAP组29例,予BiPAP治疗,rhBNP组23例,予常规吸氧治疗加重组脑钠肽治疗。所有患者都同时接受常规抗心力衰竭药物治疗,并采用漂浮导管,分别观察记录两组患者治疗前及后10、20、30min、1、2h的肺毛细血管嵌压(PCWP),动脉血气(PaO2、PaCO2、SaO2)、临床症状及心率(HR)、呼吸频率(RR)、血压的变化,并作统计学分析。结果两组患者经治疗后临床症状及PaO2、PaCO2、SaO2、HR、RR、MAP、PCWP等各项指标都有改善,但应用BiPAP组患者动脉血氧改善更快,肺毛细血管嵌压下降更明显,起效时间更短,且差异有显著性(P<0.05)。结论无创性BiPAP通气治疗急性左心力衰竭能更加迅速改善患者的低氧血症和降低PCWP,是治疗急性左心力衰竭更加快速、有效的方法。

Objective To assess the efficacy of noninvasive bi-level positive airway pressure（BiPAP） ventilation and rhBNP on acute left heart failure.Methods Fifty-two patients with acute left heart failure were randomly divided into two groups.BiPAP group：29 patients were treated by BiPAP accessory machines with traditional drugs.rhBNP group：23 patients were treated by rhBNP with traditional drugs and oxygen treatment.We evaluated all patients＇ PCWP by using floating catheter and the changes of clinical symptoms,arterial blood gas indexes（PaO2,PaCO2,SaO2）,heart rate and blood pressure.Results The clinical symptom and PaO2,PaCO2,SaO2,HR,RR,MAP,PCWP were improved,while the improvement of PCWP and PaO2 were more efficiency in the BiPAP group comparing to the rhBNP group,the efficient time was more fast,and the changes were significant different（P0.05）.Conclusion Noninvasive BiPAP ventilation can improve symptoms and hypoxemia and depressed PCWP the in patients with acute left heart failure.It is a feasible and effective method in treating acute left heart failure.