早期应用无创正压通气在急性左心衰抢救中的价值

Value of the early application of noninvasive positive pressure ventilation in the rescue of acute left heart failure

目的探讨无创正压通气在急性左心衰竭抢救中的价值及安全性。方法将71例急性左心功能衰竭患者随机分为常规治疗组(35例)和无创通气组(36例)。常规治疗组给予吸氧及药物治疗;无创正压通气组在常规药物治疗同时给予无创正压通气,观察治疗前及后1/2h,1h的血压、心率、呼吸频率及血气分析等临床指标的变化情况,症状缓解时间,抢救成功率及不良反应的发生率。结果两组治疗后的血压、心率、呼吸频率及血气分析等临床指标均较治疗前有明显改善,无创通气组与常规治疗组相比除血压外其差异有显著性(p<0.05);无创正压通气组有4例治疗失败,3例改用有创通气,1例死亡,成功率88.9%(32/36);常规治疗组13例行有创通气,其中4例死亡,成功率62.8%(22/35),两组比较差异有显著性(x2=6.604,p=0.01)。无创通气组症状缓解时间为(40.7±12.9)min,明显短于常规组(76.5±10.9)min,两组比较差异有显著性(t=10.624,p<0.001)。3例出现胃胀气,不良反应发生率8.3%(3/36)。结论早期应用无创正压通气能迅速缓解急性左心衰竭患者的临床症状,提高抢救成功率,是抢救急性左心衰安全有效的治疗手段。

【Objective】 To probe into the value and safety of the noninvasive positive pressure ventilation in the rescue of acute left heart failure.【Methods】 A total of 71 cases patients with acute left heart failure were at random divided into regular treatment group（35 cases） and noninvasive ventilation group（36 cases）.The oxygen inspiration and drug treatment were carried out in the regular treatment group,while the regular drug treatment plus noninvasive positive pressure ventilation were performed in the noninvasive ventilation group.The changes of the clinical indexes like blood pressure,heart rate,breathing rate and blood-gas analysis,as well as the symptom releasing time,successful rate in rescue and the incidence rate of harmful reaction on 1/2 hour or 1 hour before or after the treatment were respectively observed.【Results】 The clinical indexes in two groups like blood pressure,heart rate,breathing rate and blood-gas analysis obviously improved comparing with those before the treatment.The differences（except the blood pressure） between the noninvasive ventilation group and the regular treatment group were obvious（P0.05）.In the noninvasive ventilation group,4 cases were failure in treatment,among them 3 cases were changed to be treated by invasive ventilation and 1 case was dead with successful rate of 88.9%（32/36）.In the regular treatment group,13 cases were conducted invasive ventilation,among them 4 cases were dead with successful rate of 62.8%（22/35）.The differences were obvious in two groups（x2=6.604,p=0.01）.The symptom releasing time in the noninvasive ventilation group was 40.7±12.9 minutes,which was rather shorter than that in the regular treatment group（76.5±10.9 minutes）.The differences between two groups were obvious（t=10.624,P0.001）.3 cases had gaseous distention with the harmful reaction rate of 8.3%（3/36）.【Conclusion】 The early application of noni-nvasive positive pressure ventilation could rapidly release the clinical symptom of patients with acute left heart failure and improve the successful rate of rescue,which is a safe and effective treatment method for rescuing the acute left hear failure.