无创呼吸机在老年患者急性左心衰竭救治中的应用

The study on the application of non - invasive ventilation in acute left - sided heart failure of elderly patients

目的探讨无创呼吸机在急性左心衰竭老年患者急救中的应用效果，为临床提供参考。方法选取84例急性左心衰竭老年患者，采用数字表法随机分为对照组和治疗组，两组均给予常规的方法进行治疗，治疗组在此基础上加用无创呼吸机辅助治疗，比较两组患者经治疗后的主要生理指标变化、临床疗效及预后等。结果经治疗后，对照组临床总有效率为61．9％，治疗组为88．1％，两组总有效率差异有统计学意义（X2=3．841，P〈0．05）；对照组治疗前呼吸频率、心率、收缩压、氧饱和度和动脉血气指标氧分压分别为（28．70±1．01）次／min、（133．22±13．20）次／min、（112．87±14．02）mmHg、（55．60±10．56）mmHg、（80．25±3．26）％，治疗后分别为（20．04±1．42）次／min、（95．83±14．56）次／min、（96．08±13．84）mmHg、（79．86±11．69）mmHg、（90．24±3．45）％；观察组治疗前呼吸频率、心率、收缩压、氧饱和度和动脉血气指标氧分压分别为（28．87±1．34）次／min、（135．36±10．98）次／min、（110．90±13．65）mmHg、（57．80±11．35）mmHg、（81．33±3．34）％，治疗后分别为（15．86±1．13）次／min、（84．22±11．82）次／min、（84．26±10．27）mmHg、（89．31±12．21）mmHg、（99．35±3．96）％；经治疗后，两组患者的主要生理指标均有所改善（t≥5．523，P〈0．05），但治疗组各主要生理指标的改善程度较对照组差异均有统计学意义（t=14．927、4．186、4．445、3．834、11．241，均P〈0．05）；治疗组的好转时间为（12．7±4．1）h，显著短于对照组的（20．8±5．6）h（t=7．563，P〈0．05）；治疗组的住院时间为（11．8±3．9）d，显著短于对照组的（18．5±4．9）d（t=6．933，P〈0．05）；治疗组的病死率为2．38％，显著低于对照组的16．67％（x2=2．488，P〈0．05）。结论在常规治疗的基础上，使用无创呼吸机辅助治疗急性左心衰竭老年患者，可显著改善主要生理指标，提高临床治疗的效果，且预后良好。

Objective To analyze characteristics of patients with acute left ventricular failure, to explore application of non - invasive ventilator in elderly patients with acute left ventricular failure in first aid, and to provide reference for clinical practice. Methods The 84 cases of elderly patients with acute left ventricular failure were selected, in accordance with the random number table. They were divided into control group and treatment group, both groups were given conventional drugs and methods of treatment, while the treatment group was treated by using of non - invasive ventilator - assisted therapy based on the control group. The main changes in physiological indicators of treatment, clinical efficacy and prognosis of the two groups were compared. Results After treatment, in the control group,the clinical total effective rate was 61.9% , while in the treatment group was 88.1% , there were significant differences （ X2 = 3. 841,P 〈 0.05 ）. Before treatment, RR, HR, SBP, PaO2 and SaO2 of the control group were （28.70 ± 1.01）min, （133.22 ± 13.20） rain, （112.87 ± 14.02） mmHg, （55.60 ±10.56） mmHg and （80.25 ± 3.26）% respectively, while the data after treatment were （ 20.04 ± 1.42 ） min, （ 95.83±14.56 ） rain, （ 96.08 ± 13.84 ） mmHg, （79.86 ± 11.69 ） mmHg and （90.24 ±3.45 ） %. Before treatment, RR, HR, SBP, PaO2 and SaO2 of the treatment group were （ 28.87 ± 1.34 ）min, （ 135.36 ±10.98 ） min, （ 110.90± 13.65 ） mmHg, （ 57.80 ± 11.35 ） mmHg and （81.33±3.34）%,while the data after treatmen was （15.86 ±1. 13）min,（84.22 ±11.82）min,（84.26 ± 10.27） mmHg, （89.31± 12.21 ）mmHg and （99.35 ±3.96）%. Arterial blood gas indicators in the two groups had improved（t ≥5. 523, P 〈 0.05 ）, but the degree of improvement in the treatment group compared with the control group was significant difference （ t = 14.927,4. 186,4.445,3. 834,11. 241, all P 〈 0.05 ）. The turnaround time of the treatment group was （12.7 ± 4.1 ）h ,which was significantly lower than that of control group [ （20.8 ± 5.6 ）h （t = 7. 563, P 〈 7. 563 ） ]. The length of hospital stay in treatment group was （ 11.8 ± 3.9） d, significantly shorter than that in the control group[ （ 18.5 ± 4.9） d （ t = 6. 933, P 〈 0.05 ） ]. The mortality of treatment group was 2.38%, which was significantly lower than 16.67% of control group （ X2 = 2. 488, P 〈 0.05 ）. Conehlsion On the basis of conven- tional treatment, the use of non - invasive ventilator - assisted therapy in elderly patients with acute left ventricular failure, can significantly improve the main physiological indicators, the effect of improving the clinical treatment and the prognosis is good.