无创呼吸机正压通气治疗急性左心衰竭在临床中应用

Noninvasive positive pressure ventilation in treatment of acute left heart failure

目的:探讨全封闭面罩接呼吸机无创正压通气在急性心功能不全时的治疗价值。方法:对45例急性心功能不全的患者,在常规抗心衰治疗的基础上加用全封闭面罩接呼吸机无创正压通气治疗,同时进行动脉血气、心率、呼吸频率等生命体征的检测和分析。结果:本组患者40例(89%),经全封闭面罩接呼吸机无创正压通气后,临床症状在30 min病情均有明显改善,心率、呼吸频率均显著低于治疗前(P<0.01);而动脉血氧饱和度(SaO2)均显著上升(P<0.01),6～24 h脱机,总有效率为89%。3例因为患者面罩密封性不好,呼吸机提示漏气严重,后改为气管插管有创机械通气进行抢救。2例急性左心衰并发慢性肺部阻塞性病变的患者使用呼吸机后出现动脉血二氧化碳分压(PaCO2)升高,出现神志模糊及呼吸暂停现象,停用呼吸机。结论:急性心功能不全伴低氧血症的患者,早期应用全封闭面罩接呼吸机无创正压通气能迅速纠治并改善心功能,并发症少,是一种安全有效的治疗方法。

AIM： To study the clinical value of noninvasive positive pressure ventilation （NPPV） by enclosed mask in the treatment of acute left heart failure. METHODS ： Forty-five patients with acute left heart failure treated with drug therapy for 15 min received NPPV treatment. Symptoms and signs, respira- tory rate, heart rate and oxygen saturation of arterial blood （02sat-artery） were observed, respectively, before and after NPPV. RESULTS ： Forty patients were relaxed clinically with the clinically effective rate reaching 89%. Respiratory rate and heart rate decreased significantly （P 〈 0. 01 ） and O2sat-artery increased significantly （P 〈0.01 ） after NPPV treatment. Of the other five cases, two cases had unsuitably enclosed mask and three cases had hypercarbohemia. CONCLUSION： NPPV with enclosed mask is a safe and effective therapy for patients with severe acute left heart failure.