无创通气治疗急性心肌梗死合并急性左心衰竭疗效观察

The Effects of Non-invasive Ventilation on Patients with Acute Myocardial Infarction Complicated with Acute Left Ventricular Failure

目的观察无创性面罩双水平气道正压(BiPAP)通气对急性心肌梗死(AMI)合并急性左心衰竭患者的疗效,观察治疗前后生命体征、血气分析、血清B型尿钠肽(BNP)、肌钙蛋白I(cTnI)以及左室射血分数(LVEF)的变化。方法 AMI合并急性左心衰Killips分级Ⅲ-Ⅳ级患者46例,随机分BiPAP治疗组(23例)和常规治疗组(23例)。常规治疗组给予吸氧、卧床、抗血小板、硝酸酯类、利尿剂、抗凝、溶栓、急诊经皮冠状动脉介入治疗(PCI)等治疗。BiPAP组在前者基础上加用BiPAP通气治疗。记录人院即刻和24h生命体征,行动脉血气分析;测定人院即刻、24h、48h和72h血清BNP和cTnI水平;采用床旁超声心动图测定入院即刻和72h LVEF的变化。结果 BiPAP通气治疗可迅速改善患者的临床症状,24h后与常规治疗组相比,BiPAP治疗组患者收缩压下降,心率减慢,呼吸频率下降,血气分析显示氧分压明显提高。BiPAP治疗组血清BNP和cTnI水平显著降低(P<0.05),72h后降低更明显(P<0.01);BiPAP治疗组LVEF于72h后明显升高(P<0.05)。结论急性心肌梗死合并急性左心衰患者早期使用BiPAP通气治疗安全有效,是提高抢救成功率的有效手段。

Objective To observe the effects of non-invasive hi-level positive airway pressure （BiPAP） ventilation on patient with acute myocardial infarction （AMI） complicated with acute left ventricular failure patients, and to observe symptoms,the levels of brain natriuretic peptide （BNP）, cardiac troponin I （cTnI）, the changes of left ventricular ejection fraction, the peak blood current velocity ratio of early diastolic left atrioventricular valve vs advanced diastolic left atrioventricular valve （E/A） in prior and post treatment. Methods Forty-six patients with AMI complicated with acute left ventricular failure （klilips=iii,iv） were randomly divided into BiPAP group （23 cases） and conventional therapy group （23 cases）. In conventional therapy group, antiplatelet drugs, nitrate esters, cardiac stimulants and diuretics were used, and the measures of intra-venous thrombolysis, emergency percutaneous coronary interventional（PCI） therapy were used, too. In BiPAP group, non-invasive BiPAP ventilation was used base on the therapy of conventional therapy group. The protocols of the life signs of immediate and 24 hours, aterial bood gas analysis, the levels of BNP, myocardial enzyme list and cTnI of 24 hours,48 hours and 72 hours were recoded. The changes of LVEF and the ratio of E/A of immediate and 72 hours were detceted by bedside ultrasonic cardiogram. Results Non-invasive BiPAP ventilation threapy could release the patients＇ symptoms rapid- ly. Compared with conventional therapy group, the systolic blood pressure, the heart rates and the respiratory rates of the BiPAP group patients were decreased, and the oxygen partial pressure was improved within 24 hours. The levels of BNP, myocardial enzyme list（P〈 0.05）, cTnI were decreased significantly within 24 hours（P〈0.05）, and lower within 72 hours（P〈0.01）. The LVEF was elevated（P〈 0.05）. Conclusions Early non-invasive BiPAP ventilation threapy is safe and reliable, and is an useful measure to improve the the achievement ratio in emergency.