有创呼吸机辅助通气联合吗啡治疗重症急性左心衰竭疗效的观察

Invasive ventilator assisted ventilation combined with morphine in treating severe acute left heart failure

目的 探讨有创呼吸机辅助通气联合吗啡治疗重症急性左心衰竭的疗效.方法 回顾性分析41例重症急性左心衰竭患者抢救治疗过程,有创呼吸机辅助通气联合吗啡治疗组（有创组）28例,拒绝气管插管呼吸机辅助通气组（对照组）13例,两组均给予吗啡5 ～ 10 mg静脉注射等常规药物治疗,观察并记录相同治疗时间内的心率、呼吸频率、血气分析及超声检测左心室射血分数（LVEF）等临床指标的变化情况,以及症状缓解时间、抢救成功率等.结果 有创组治疗后的心率、呼吸频率、血气分析及LVEF等临床指标均较治疗前有明显改善；两组疗效的秩和检验结果显示,有创组临床疗效优于对照组（P =0.0491）.有创组28例,死亡2例,其中1例在气管插管后6h内死亡,成功率92.8％（26/28）;对照组13例,死亡5例,其中2例在治疗8h内死亡,成功率61.5％（8/13）.两组死亡人数差异有统计学意义（x2=4.1374,P=0.0419）.有创组症状缓解时间为（15.2±6.9）h,明显短于治疗组[（23.6 ±9.8）h,t=2.7233,P=0.0104].结论 有创呼吸机辅助通气联合吗啡治疗能缓解重症急性左心衰竭患者的临床症状,提高抢救成功率,是抢救重症急性左心衰竭的一种安全、有效的治疗手段.

Objective To investigate the efficacy of invasive mechanical ventilation combined with morphine in treating severe acute left heart failure. Methods The course of rescue forty - one patients with severe acute left heart failure was analyzed retrospectively. Twenty - eight cases were treated with invasive ventialtor assisted ventilation combined with morphine （invasive group） ; thirteen cases who refused endotracheal intubation assisted ventilation were control group. Both groups were given 5 - 10 mg intravenous morphine and routine medicine. Clinical indicators such as heart rate, respiratory rate, blood gas analysis and left ventricular ejection fraction （LVEF） as well as remission time and the survival rate at the same time were recorded. Results There was a significant improvement after treatment in clinical indicators such as heart rate, respiratory rate, blood gas analysis and LVEF in invasive group. Rank sum test showed that the efficacy of invasive mechanical ventilation combined with morphin was better than control group （P =0. 0491 ）. Two patients died in invasive group, one patient died within six hours after endotracheal intubation, and the success rate was 92. 8% （26/28）. However, 5 patients died in control group, including 2 patients who died within eight hours after treatment, the success rate was 61.5% （8/13）. The mortality was significantly different in two groups （X^2 =4. 1374, P = 0. 0419）. The remission time of symptom in invasive group （ 15.2 ± 6.9 h） was shorter than control group （23.6± 9.8 h） obviously, which has significant statistically difference （ t = 2. 7233, P = 0. 0104 ）. Conclusion Invasive mechanical ventilation combined with morphine can relieve clinical symptoms and improve success rate in severe acute left heart failure patients. It is a safeand effective means of treatment for severe acute left ventricular failure.