早期无创正压通气治疗急性左心衰竭的临床研究

Early non-invasive positive pressure ventilation in treatment of serious hypoxemia following acute left heart failure

目的 观察早期无创正压通气（NlPPV）对急性左心衰竭所致严重低氧血症的治疗效果.方法 40例急性左心衰竭（心功能Ⅳ级）患者随机分为NIPPV组和对照组,2组均常规给予强心、利尿、镇静、扩血管等对症支持治疗,对照组给予普通高浓度吸氧,NIPPV组在对症支持治疗的基础上采用双向气道正压呼吸机（BiPAP）经面罩双向正压通气治疗.观察治疗2h后2组患者心率（HR）、呼吸频率（RR）、收缩压（SBP）、动脉血氧饱和度（SaO2）、血气分析和临床症状、体征的变化.结果 治疗2h后,NIPPV组患者的RR[（19.55±1.88）次/min]、HR[（96.40±2.80）次/min]、SBP[（116.30±8.95）mmHg]、pH值（7.40±0.02）、SaO2[（93.57±1.18）%]、动脉血氧分压（PaO2）[（75.58±4.61）mmHg]、动脉血二氧化碳分压（PaCO2）[（38.69±3.06）mn Hg]与对照组[RR（21.85±3.51）次/min、HR（103.20±6.78）次/min、SBP（122.50±6.13）mm Hg、pH值（7.35±0.05）、SaO2（91.97±1.85）%、PaO2（68.38±7.95）mm Hg、PaCO2（43.61±2.65）mm Hg]比较,差异均有统计学意义（t值分别为2.582、4.146、2.558、3.534、3.256、3.505、5.428,P均＜0.05）,治疗前差异均无统计学意义.NIPPV组患者缺氧程度得到有效改善,总有效率95%（19/20）;对照组总有效率70%（14/20）,2组总有效率比较差异有统计学意义（χ2=4.329,P＜O.05）.结论 急性左心衰竭患者在给予常规抗心力衰竭治疗的同时应用BiPAP正压无创通气治疗可以较快纠正机体缺氧状况,改善心功能,缩短病程.

Objective To observe the effect of early non-invasive positive pressure ventilation（NIPPV）on the treatment of serious hypoxemia induced by acute left heart failure. Methods Forty patients with acute left heart failure（ Grade Ⅳ heart function）were randomly divided into two groups. Patients in both groups accepted supportive treatment included cardiotonics, diuretics, vasodilators, in additional to these high concentrations of oxygen were given in conventional group, and non-invasive positive pressure ventilation were given in NIPPV group by biphasic positive airway pressure（BiPAP）. Systolic blood pressure, heart rate, respiratory rate, blood-gas analysis（ pH, PaO2, PaCO2, SaO2 ）and clinical signs were observed at 2 hours after treatments. Results Compared to control,RR（ [ 19.55 ± 1.88] vs [21.85 ±3.51 ] ） BPM] ,HR （ [96.40 ±2.80] vs[ 103.20 ±6.78 ] BPM）, SBP （ [ 116.30 ± 8.95 ] mm Hg vs [ 122.50 ± 6.13 ] mm Hg）, pH （7.404 ± 0.027 vs 7.358 ±0.05） ,SaO2 （ [93.57 ± 1.18]% vs [91.97 ± 1.85]% ） ,PaO2 （ [75.58 ±4.61 ]mm Hg vs [68.38 ±7.95]mm Hg）, PaCO2 （ [ 38.69 ± 3.06 ] mm Hg vs [ 43.61 ± 2.65 ] mmHg） were significantly different in NIPPV group（ t = 2.582,4.146,2.558,3.534,3.256,3.505,5.428, Ps 〈 0.05 ）. We found no significant differences in the comparisons before treatments. Hypoxia improved in NIPPV group,and the total effective rate was 95% in NIPPV group and 70% in control group,which showed significant difference（ x2 =4.329 ,P 〈0.05 ） Conclusion BiPAP non-invasive positive pressure ventilation combined with routine treatment in treating heart failure, could promptly correct hypoxia, improve heart function and shortening disease course.