急性心肌梗死合并左心衰竭患者急救过程中应用无创正压通气的效果分析

Effect analysis of applying non-invasive positive pressure ventilation in the first-aid process of acute myocardial infarction combining with left heart failure

目的探讨急性心肌梗死合并左心衰竭患者急救过程中应用无创正压通气的临床价值。方法选取2012年1月~2015年12月我院收治的120例急性心肌梗死合并左心衰竭患者进行回顾性研究分析,根据患者的辅助吸氧方法将其分为对照组与观察组,各60例。对照组采用高浓度面罩吸氧治疗,观察组采用无创正压通气治疗,比较两组患者治疗前后的二氧化碳分压（Pa CO2）、氧分压（Pa O2）、脑利钠肽（NT-pro BNP）、左心射血分数（LVEF）,比较两组患者的机械通气治疗时间、住院时间以及病死率。结果治疗后,两组患者的Pa O2、Pa CO2、NT-pro BNP、LVEF均明显改善（P〈0.05）,但观察组的Pa O2、Pa CO2、NT-pro BNP、LVEF优于对照组（P〈0.05）;与对照组比较,观察组机械通气治疗时间、住院时间均明显更短（P〈0.05）,其病死率明显更低（P〈0.05）。结论在急性心肌梗死合并左心衰竭的急救过程中,采用无创正压通气治疗可有效改善患者的心功能,缓解心肌缺血、缺氧症状,减少死亡事件。

Objective To explore the clinical value of applying non-invasive positive pressure ventilation（NIPPV） in the first-aid process of acute myocardial infarction（AMI） combining with left heart failure.Methods From January 2012 to December 2015,based on the sequence of admission into the hospital,120 patients with AMI and left heart failure admitted into our hospital were retrospectively analyzed.According to different auxiliary oxygen inhalation methods,they were evenly divided into control group and observation group.In the control group,mask in high concentration was used for oxygen inhalation,while in the observation group,NIPPV was adopted.Partial pressure of carbon dioxide（Pa CO2）,oxygen partial pressure（Pa O2）,brain natriuretic peptide（NT-pro BNP）,left ventricular ejection fraction（LVEF）,treatment time of mechanical ventilation,hospital stay,and mortality rate were compared in the two groups.Results After therapy,the indexes of Pa O2,Pa CO2,NT-pro BNP,and LVEF were all greatly improved（P〈0.05）.The improvement of these indexes in the observation group were superior than those of control group（P〈0.05）.Compared with the control group,treatment time of mechanical ventilation and hospital stay in the observation group were much shorter in comparison with those in the control group（P〈0.05）,the mortality rate was lower in the observation group（P〈0.05）.Conclusion In the first-aid of process of AMI combining with left heart failure,application of NIPPV can effectively improve patient′ s cardiac function,alleviate myocardial ischemia and anoxia,as well as reduce the death incident.