呼吸机正压通气治疗在急性心肌梗死并左心衰竭中的应用价值

Application value of ventilator positive airway pressure therapy in acute myocardial infarction patients with left ventricular failure

目的探讨呼吸机无创正压通气在老年人急性心肌梗死并左心衰竭中的临床应用价值。方法将70例急性心肌梗死并左心衰竭患者随机数字表法分为观察组和对照组，对照组患者接受常规治疗，观察组患者在其基础上应用无创正压通气，比较两组患者治疗后相关指标及两组患者转为气管插管比例、病死率和住院时间。结果与对照组比较，观察组患者二氧化碳分压（PaCO2）、呼吸频率（RR）、心率（HR）及收缩压（SBP）改善更显著，氧分压（Pa02）及氧饱和度（Sa02）升高更显著（t=4．2588、5．144、7．127、4．2814、6．4719、6．2629，均P〈0．05）；观察组患者心搏量（sV）、射血分数（EF）升高更显著，中心静脉压（CVP）降低更显著（t=12．0527、14．0937、14．6425，P〈0．05）；观察组患者转为气管插管及死亡比例均显著低于对照组，平均住院时间显著短于对照组（X2=4．6289、4．2000，t=6．3892，均P〈0．05）。结论在急性心肌梗死并左心衰竭的治疗中，无创正压通气能够明显改善患者心脏功能、肺通气及换气功能，提高治疗效果。

Objective To investigate the application value of breathing machine noninvasive positive pressure ventilation in acute myocardial infarction patients with left ventricular failure. Methods 70 acute myocardial infarction patients with left ventricular failure were randomly divided into observation group and control group, the control group received conventional treatment, on the basis of the control group, patients in the observation group were treated with noninvasive positive pressure ventilation. The treatment indicators and the proportion of converted to endo- tracheal intubation, mortality and length of hospital stay were compared between the two groups. Results Compared with the control group, the PaCO2, RR, HR and SBP of observation group reduced more significantly, PaO2 and SaO2 increased more significantly （ t = 4. 2588,5. 144,7.127,4.2814,6.4719,6. 2629, all P 〈 0.05 ）. Compared with the control group, the SV and EF of observation group increased more significantly, CVP decreased more significantly （ t = 12. 0527,14.0937,14. 6425, all P 〈 0.05 ）. The patients converted to endotracheal intubation and mortality ratio were signifieantly lower than the control group, the average length of stay was significantly shorter than the control group （ X2 = 4. 6289,4. 2000, t = 6. 3892, all P 〈 0.05 ）. Conclusion In the treatment of acute myocardial infarction pa- tients with left ventricular failure, noninvasive positive pressure ventilation can significantly improve cardiac function, lung ventilation and ventilatory function,increase the therapeutic effect.