急诊早期应用BiPAP无创机械通气治疗急性左心衰竭临床研究

A Clinical study of using noninvasive mechanical bi-level positive airway pressure ventilation early in the treatment of acute left heart failure in emergency

目的评价急诊早期应用无创机械双水平正压通气(BiPAP)治疗急性左心功能衰竭的疗效。方法 68例急性左心功能衰竭患者被随机分为2组,34例早期BiPAP治疗组在常规抗心衰基础药物治疗的同时,即早期配合使用BiPAP治疗,34例常规治疗组在常规抗心衰基础药物治疗上加用鼻导管给氧治疗,治疗无效时再改用BiPAP治疗,比较其对临床症状、心功能、血气分析、无创机械通气时间、气管插管率I、CU住院时间的影响。结果 2组患者通气治疗后,血气分析中pH、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、ABP、呼吸频率(RR)、心率(HR)等参数与治疗前比较有显著好转(P<0.01),与常规治疗组比较,PaO2、RR、HR明显改善(P<0.05)。患者入院至上机时间、症状缓解时间、平均上机时间、ICU住院时间明显缩短(P<0.05),气管插管率降低(P<0.05),早期治疗组2 h显效率为88.2%,显著优于常规治疗组(76.4%)。结论急诊早期应用BiPAP无创机械通气治疗急性左心功能衰竭能迅速纠正缺氧、改善心功能,可作为抢救的一种安全、有效方法。

Objective To assess the efficacy of using noninvasive bilevel positive airway pressure(BiPAP) ventilation early in the treatment of acute left heart failure in emergency.Methods 68 patients with acute left heart failure were divided into two groups randomly: treatment group and control group.The 34 patients in the early BiPAP treatment group were treated with noninvasive bi-level positive airway pressure(BiPAP) ventilation early in addition to conventional treatment.Another 34 patients in the control group were treated by nasal pipe with oxygen in addition to conventional treatment.If the treatment was of no effect,then change to BIPAP treatment.Results Afler BiPAP ventilation the clinical symptoms of the both groups were improved significantly;their arterial blood gas parameters(pH,PaO2,PaCO2),respiration rate(RR) and heart rate(HR) showed a significant improve ment(P<0.01);compared with conventional treatment group,PaO2,RR,HR were improved(P<0.05).The total 2 h efficiency rate of early BiPAP group was 88.2%,more than that of routine treatment group(76.4%).Conclusion Using noninvasive BiPAP ventilation early in emergency could improve hypoxemia and cardiac function in patients with acute left heart failure and be safe and effective.