高龄重度急性左心衰竭并呼吸衰竭患者的机械通气治疗

Mechanical ventilation therapy for aged patients with severe acute left heart failure combined with respiratory failure

目的 总结在高龄重度急性左心衰竭 (ALVF)合并急性呼吸衰竭 (ARF)患者应用机械通气治疗的临床经验。方法 回顾性总结 10年间 10 2例高龄重度ALVF并ARF患者应用机械通气治疗的方式、好转率、病死率和合并症 ,并将合并Ⅰ型ARF(ARF Ⅰ ) (4 2例 )和Ⅱ型ARF(ARF Ⅱ ) (6 0例 )两组患者资料进行比较。结果 10 2例 115次机械通气途径 :经鼻面罩给氧 18次 ,经鼻插管 6 8次 ,经口插管 2 9次 ;通气方式 :容量控制 115次 ,压力控制 2 5次 ,稳定气道正压 (CPAP) 2 6次 ,呼气终末加压(PEEP) 4 5次。病情好转率在全部病人、ARF Ⅰ和ARF Ⅱ组分别是 6 0 8% ,6 9 0 %和 5 5 0 % (两组比较P <0 0 5 ) ;病死率分别是 39 2 % ,30 9% ,45 0 % (两组比较P <0 0 5 )。用呼吸机过程中的主要合并症在全部病人为 :心律失常 37 3% ,低血压 35 3% ,肺感染 34 3% ,消化道出血 31 4% ,酸碱失衡 2 0 6 % ,张力性气胸 2 9%。两组比较显示ARF Ⅱ组病情重 ,病死率高 ,合并症多。结论 高龄重度ALVF并ARF患者机械通气治疗难度大 ,风险高 ,但只要严格掌握适应征及合适的通气方式 ,注意防治合并症 ,仍可以取得良好疗效 ,挽救大部分患者的生命。

Objective To sum up the clinical experience of mechanical ventilation in treatment of aged patients with severe left heart failure (ALVF) combined with acute respiratory failure (ARF). Methods A retrospective analysis was carried out of the pattern, improvement rate, mortality, and complication of medical ventilation applied on 102 aged patients (82 0 9 9 yrs) with severe ALVF and ARF in the past 10 years. The data of the patients with ARF type Ⅰ (42 cases) and the data of the patients with ARF type Ⅱ (60 cases) were compared. Results The route of mechanical ventilation in 102 patients (115 times) included administration of oxygen via nasal mask (18 times), nasal intubation (69 times) and oral intubation (29 times). The ventilation pattern included volume control (115 times), pressure control (25 times), CPAP (26 times), and PEEP (45 times). The improvement rates in the patients as a whole, group ARF I, and group ARF Ⅱ were 60 8%, 69 0%, and 55 0% respectively ( P <0 05 between each two groups). The mortality rates in the patients as a whole, group ARF Ⅰ, and group ARF Ⅱ were 39 2%, 30 9%, and 45 0% respectively ( P <0 05). The complications ever found in all of the patients included arrhythmia (37 3%) Hypotension (35 3%), pulmonary infection (34 3%), bleeding of gastrointestinal tract (31 4%), acid0base unbalance (20 6), and pressure pneumothorax (2 9%). The clinical condition (severity, mortality, and complication rate) was more critical in group ARF Ⅱ than in group ARF I. Conclusion Mechanical ventilation is conducted with more difficulty and higher risk for aged patients with severe ALVF. However, while operated appropriately, it will be effective.