药物联合无创机械通气治疗顽固性心力衰竭的效果观察

Effect of the drugs combined with mechanical ventilation in the treatment of refractory heart failure

目的观察临床应用的4种药物(硝普钠、多巴酚丁胺、硝酸甘油和卡托普利)联合无创机械通气治疗顽固性心力衰竭(RHF)的疗效。方法将108例RHF患者随机分为联合组(60例)和对照组(48例),分别予药物联合无创正压通气治疗和无创正压通气治疗,记录患者心功能指标、动脉血气指标及脑利钠肽(BNP)的变化情况。结果治疗后,联合组心功能指标,包括射血分数(EF)、每搏量(SV)、心排血量(CO)、心脏指数(CI)值明显升高,且明显高于对照组(均P<0.01),联合组患者PaO_2、SaO_2及BNP水平均明显降低,PaCO_2明显升高,且均较对照组改善明显(均P<0.01),联合组临床疗效优于对照组(Hc=28.7168,P<0.01),且未见不良反应。结论药物联合无创机械通气可有效缓解RHF患者的临床症状,改善其心功能,值得临床推广与应用。

Objective To investigate the clinical efficacy of 4 drugs （sodium nitroprusside, dobutamine hydrochloride, nitroglycerin and captopril） combined with mechanical ventilation in the treatment of refractory heart failure （RHF）. Methods 108 RHF patients were divided into Combination Group （60 cases） and Control Group （48 cases）, receiving the treatment with the drugs combined with mechanical ventilation and simple mechanical ventilation, respectively. The changes in heart function indexes, clinical symptoms, artery blood gas index and BNP were recorded. Results After treatment, the heart function indexes （EF, SV, Co, CI） in Combination Group were significantly increased, and significantly higher than those of Control Group （P〈0.01）; the PaO2, SaO2 and BNP levels in Combination Group were significantly reduced, but PaCO2 levels in Combination Group was significantly increased, showing a more significant improvement compared with those of Control Group （P〈0.01）. Combination Group had a clinical efficacy superior to Control Group （Hc=28.7168, P〈0.01）, and had no obvious adverse reactions. Conclusion Drugs combined with mechanical ventilation cab effectively alleviate the clinical symptoms of RHF patients and improve their cardiac function. It is worthy clinical popularization and application.