无创双水平气道正压通气联合常规药物治疗慢性心力衰竭急性加重期的效果观察

Effect of non-invasive ventilator with bi-level positive airway pressure combined with conventional medication on acute exacerbation of chronic heart failure

目的探讨无创双水平气道正压(Bi PAP)呼吸机联合常规药物在治疗慢性心力衰竭急性加重期患者中的应用价值。方法回顾性分析144例慢性心力衰竭急性加重期患者的临床资料,对照组75例,给予常规药物治疗,研究组69例,在常规药物治疗的基础上给予使用Bi PAP呼吸机辅助通气。对比分析两组患者治疗前后的呼吸、心率、血压、N末端B型利钠肽原(NT-pro BNP)、左室射血分数(LVEF)以及血气分析(p H、Pa O_2、Pa CO_2)等指标变化。结果两组患者经治疗后收缩压(SBP)、心率(HR)、呼吸频率(RR)、LVEF、Pa CO_2、p H、Pa O_2均较前改善(P<0.05)。治疗后,研究组SBP、HR、RR及Pa CO_2均低于对照组,而LVEF、p H、Pa O_2高于对照组(P<0.05);治疗3 d后两组NT-pro BNP水平较前下降,且研究组NT-pro BNP水平低于对照组(P<0.05)。结论慢性心力衰竭急性加重期患者应用Bi PAP呼吸机联合常规药物治疗效果显著,能显著改善患者的心衰症状,并且操作简单、安全性高,值得在临床上推广应用。

Objective To explore the application value of non-invasive ventilator with bi-level positive airway pressure（ Bi PAP）combined with conventional medication in acute exacerbation of chronic heart failure. Methods Clinical data of 144 patients with acute exacerbation of chronic heart failure were retrospectively analyzed. Seventy-five patients were enrolled in the control group and were given the conventional medication. And 69 patients were enrolled in the study group and were given mechanical ventilation with Bi PAP on the basis of conventional medication. The respiratory rate（ RR）,heart rate（ HR）,blood pressure,N-terminal pro-B-type natriuretic peptide（ NT-pro BNP）,left ventricular ejection fraction（ LVEF） and the indices of blood gas analysis（ including p H,Pa O2 and Pa CO2） were compared between two groups before and after treatment. Results The systolic blood pressure（ SBP）,HR,RR LVEF,Pa CO2,p H and Pa O2 in both groups were improved significantly after treatment（ P〈0. 05）. And after treatment,SBP,HR,RR and Pa CO2 were lower while LVEF,p H and PaO2 were higher in the study group compared to the control group（ P〈0. 05）. After 3 days of treatment,the levels of NT-pro BNP decreased in both groups,and the level of NT-pro BNP in the study group was significantly lower than that in the control group（ P〈0. 05）.Conclusion Mechanical ventilation with Bi PAP combined with conventional medication has a significant effect on the patients with acute exacerbation of chronic heart failure,and can remarkably improve the symptoms of heart failure. This approach is simple and safe,and is worthy of clinical application.