有创机械通气在重度急性左心衰竭救治中的临床价值

Clinical value of invasive mechanical ventilation in the treatment of severe acute left heart failure

目的探讨有创机械通气在重度急性左心衰竭救治中的临床价值。方法对本院重症医学科收治的38例经常规治疗无效而联用有创机械通气治疗的重度急性左心衰竭患者的临床资料进行回顾分析,比较有创机械通气前后血气分析结果的变化和治疗前后病情情况。结果有创机械通气后2h患者动脉血pH值、PaO2、PaCO2,SpO2、心率平均动脉压和呼吸频率等各项监测指标较有创机械通气前显著改善(P<0.01)。38例患者中有32例患者在6～96h内成功撤机,急性肺水肿和呼吸衰竭症状明显缓解,PaO2及PaCO2基本恢复正常,总有效率为84.2%(32/38);4例患者因心源性休克伴多脏器功能衰竭始终未能脱机最终死亡,2例为顽固性无脉性室性心动过速或心室颤动死亡,病死率为15.8%(6/38)。结论有创机械通气可显著改善重度急性左心衰竭患者的临床症状、体征和动脉血气分析的重要指标,在重度急性左心衰竭的救治中具有重要的临床应用价值。

Objective To explore the clinical value of invasive mechanical ventilation in the treatment of severe acute left heart failure （ALHF）. Methods The clinical data of 38 patients with severe ALHF applied invasive mechanical ventilation on the basis of conventional treatment in department of critical care medicine in our hospital were analyzed retrospeetiveh. Blood gas analysis results before and after mechanical ventilation and the disease condition before and after treatment were compared. Results After 2-hours treatment of invasive mechanical ventilation, some important indexes of patients such as arterial blood gas pH, arterial partial pressure of oxygen （PaO2）, arterial carbon dioxide partial pressures （PaCO2）, pereutaneous arterial oxygen saturation （SpO2）, heart rate （HR） and respiratory rate （RR） had been markedly improved, which compared with before invasive mechanieal ventilation （P 〈 0.01）, there were 32 patients of all 38 cases got better without the treatment of invasive mechanical ventilation in 6-96 h. Acute pulmonary edema and symptoms of respiratory failure were obviously alleviated, PaO2 and PaCO2 already returned to normal, the total effective rate was 84.2% （32/38）. 4 cases dead because cardiac shock with multiple organ failure and failed to separate from breathing machine, 2 cases dead because stubborn pulseless ventricular taehycardia or ventrieular fibrillation, the fatality rate was 15.8%（6/38）. Conclusion Invasive mechanical analysiscan of rapidly improve clinical symptoms and signs and the important index of arterial blood gas of the patients with severe acute left heart failure, it has an important clinical application to treatment severe acute left heart failure.