无创通气联合法舒地尔应用于老年慢性肺心病合并呼吸衰竭患者的疗效观察

The Effects Observation of Noninvasive Mechanical Ventilation Combined with Fasudil in the Treatment of Pulmonary Heart Disease Combined with Respiratory Failure in the Elderly Patients

目的分析无创通气联合法舒地尔应用于老年慢性肺源性心脏病（肺心病）合并呼吸衰竭患者的临床价值。方法选取2010年9月至2013年8月在四川大学华西医院呼吸内科进行住院治疗的老年慢性肺心病合并呼吸衰竭患者70例,依据随机数字表法分为两组：联合治疗组（37例）采用无创通气联合法舒地尔治疗,无创通气呼吸频率为15次/min,氧浓度为30%~40%,呼吸压力调制为4 cm H2O（1 cm H2O=0.098 k Pa）,吸气压力调制为8 cm H2O,法舒地尔每12小时30 mg静脉滴注;无创机械通气组（33例）采用无创通气治疗,方法同联合治疗组。比较两组患者的呼吸频率、心率、肺动脉压、动脉血氧分压（Pa O2）、动脉血二氧化碳分压（Pa CO2）、动脉血氧饱和度（Sa O2）、血浆脑钠肽（BNP）和临床疗效。结果联合治疗组呼吸频率、心率和肺动脉压分别为（23±5）次/min、（93±8）次/min、（43±3）mm Hg（1 mm Hg=0.133 k Pa）,均显著低于无创机械通气组的（28±3）次/min、（99±8）次/min、（52±4）mm Hg（P〈0.05）;联合治疗组的Pa O2、Pa CO2和Sa O2分别为（78±7）mm Hg、（45±6）mm Hg、（91±6）%,无创机械通气组分别为（69±6）mm Hg、（55±8）mm Hg、（85±9）%,两组比较差异均有统计学意义（P〈0.05）;联合治疗组治疗后血浆BNP为（118±31）ng/L,显著低于无创机械通气组的（136±34）ng/L（P〈0.05）;联合治疗组的临床疗效优于无创机械通气组（P〈0.05）。结论无创通气联合法舒地尔能快速、有效地治疗老年慢性肺心病合并呼吸衰竭患者。

Objective To analyze the clinical value of noninvasive mechanical ventilation combined with fasudil in the application of pulmonary heart disease with respiratory failure in the elderly patients . Methods A total of 70 patients with pulmonary heart disease combined with respiratory failure admitted to West Hospital of Sichuan University from Sep .2010 to Aug.2013 were divided into two groups according to random number-table method：combined treatment group（37 cases） and noninvasive mechanical ventilation group（33 cases） respectively.The patients in combined treatment group received noninvasive ventilation combined with fasudil,breathing rate was 15 time/min,the concentration of O2 was 30%-40%,the breathing pressure was 4 cmH2O（1 cmH2O=0.098 kPa）, the suction pressare was 8 cmH2O,fasudi was IV.infused 30 mg every 12 hours.The patients in noninvasive mechanical ventilation group received noninvasive ventila-tion（the way was the same to the combined treatment group）.The breathing rate,heart rate,pulmonary arte-rial pressure,PaO2 , PaCO2 , SaO2 , plasma BNP and clinical efficiency of the two groups were compared . Results The breathing rate of combined treatment group was lower than the noninvasive mechanical ventila-tion group[（23 ±5）times/min vs （28 ±3）times/min],heart rate was lower than the noninvasive mechani-cal ventilation group[（93 ±8） time/min vs （99 ±8） time/min],and the pulmonary arterial pressure of combined treatment group was lower than the noninvasive mechanical ventilation group [（43 ±3） mmHg vs （52 ±4） mmHg],the differences were statistically significant（P〈0.05）.The PaO2, PaCO2,SaO2 of com-bined treatment group were （78 ±7） mmHg,（45 ±6） mmHg,（91 ±6）%repectively,and those of noninva-sive mechanical ventilation group were （69 ±6） mmHg,（55 ±8） mmHg,（85 ±9）%,the differences were statistically significant（P〈0.05）.After treatment,the level of BNP of combined treatment group was lower than the noninvasive mechanical ventilation group [（118 ±31） ng/L vs （136 ±34） ng/L,P 〈0.05].The clinical curative effect of the combined treatment group was higher than the noninvasive mechanical ventilation group（P〈0.05）.Conclusion Noninvasive mechanical ventilation combined with fasudil can effectively treat the pulmonary heart disease complicated with respiratory failure in the elderly .