无创双水平气道正压通气治疗糖尿病合并慢性心力衰竭急性加重的有效性

Efficacy of non-invasive bi-level airway pressure ventilation during acute exacerbation of chronic heart failure combined with diabetes memtus

目的研究无创双水平气道正压（BiPAP）在糖尿病合并慢性心力衰竭急性加重辅助治疗中的有效性及安全性。方法对比15例2型糖尿病合并慢性心力衰竭急性加重的老年患者使用无创BiPAP治疗前后临床参数（呼吸频率、指脉氧饱和度、血压、心率、血气分析、脑钠肽、心功能NYHA分级等）的变化，统计气管插管率、呼吸机相关并发症发生率。结果与治疗前比较，无创BiPAP治疗后指脉氧饱和度、动脉血氧分压、动脉血氧饱和度升高[0．9793±0．0219比0．9187±0．0594、（112．48±24．20）mmHg（1mmHg=0．133kPa）比（84．90±32．49）mmHg、0．9828±0．0106比0．9359±0．0544]，收缩压、舒张压、心率、呼吸频率、心功能NYHA分级、脑钠肽、空腹血糖下降[（121．33±15．29）mmHg比（144．00±29．28）mmHg、（70．20±8．32）mmHg比（78．33±16．35）mmHg、（75．00±14．74）次，min比（100．00士29．41）次／rain、（18．40±3．40）次／min比（23．33±6．31）次／min、（2．13±0．64）级比（3．87±0．52）级、（1981．00±2083．68）ng／L比（3897．77±2531．68）ng／L、（6．65±1．23）mmol／L比（8．87±3．44）mmol／L]，差异有统计学意义（P〈0．01或〈0．05）；动脉血二氧化碳分压、pH值、碳酸氢根比较差异无统计学意义（P〉0．05）。无气管插管、死亡病例；无呼吸机相关并发症发生。结论无创BiPAP在糖尿病合并慢性心力衰竭急性加重的辅助治疗中能够显著改善患者心力衰竭的症状和多项临床参数，降低气管插管率及病死率。

Objective To evaluate the efficacy and safety of non-invasive bi-level airway pressure （BiPAP） in patients with acute exacerbation of chronic heart failure combined with diabetes mellitus. Methods The clinical variables were compared before and after treatment of non-invasive BiPAP,in 15 elderly patients with acute exacerbation of chronic heart failure combined with type 2 diabetes mellitus, including respiratory rate＇ pulse oxygen saturation, blood pressure, heart rate, arterial blood gas analysis, brain natriuretic peptide and NYHA class. The rates of endotracheal intubation and complications of non-invasive ventilation were analyzed. Results The pulse oxygen saturation, arterial partial pressure of oxygen, arterial oxygen saturation after treatment with non-invasive ventilation was raised compared with that before treatment with non-invasive ventilation [ 0.9793 ±0.0219 vs. 0.9187 ± 0.0594, （ 112.48 ±24.20） mm Hg（ I nun Hg = 0.133 kPa） vs. （84.90 ±32.49） mm Hg, 0.9828 ± 0.0106 vs. 0.9359 ± 0.05441, and there was significant difference （P 〈 0.01 or 〈 0,05）. Systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, NYHA class ,brain natriuretic peptide after treatment with non-invasive ventilation was reducedcompared with that before treatment with non-invasive ventilation [ （ 121.33 ± 15.29） mm Hg vs. （ 144.00 ± 29.28） mm Hg, （70.20 ± 8.32） mm Hg vs. （78.33 ± 16.35） mm Hg, （75.00 ± 14.74） beats/rain vs. （ 100.00 ± 29.41 ） beats/min, （ 18.40 ±3.40） times/rain vs. （23.33 ± 6.31 ） times/min, （2.13 ± 0.64） grades vs. （3.87 ± 0.52） grades, （ 1981.00 ± 2083.68） ng/L vs. （3897.77± 2531.68） ng/L, （6.65 ± 1.23） mmol/L vs. （8.87 ±3.44） mmol/L], and there was significant difference （P 〈0.05）. There was no significant difference in arterial partial pressure of carbon dioxide, pH and bicarbonate（P 〉 0.05 ）. There was no case of death,endotracheal intubation and complications of non-invasive ventilation. Conclusion Non-invasive ventilation improves the clinic symptoms in patients with acute exacerbation of chronic heart failure combined with diabetes mellitus, and reduces the rate of endotracheal intubation and mortality.