两种无创通气模式治疗急性左心衰竭的评价

Evaluation of two non-invasive ventilation modes in the treatment of acute left heart failure

目的探讨两种无创通气模式治疗急性左心衰竭的效果。方法将2016年11月~2017年11月在我院急诊内科治疗的80例急性左心衰竭患者按无创通气模式不同分为两组,均给予常规药物治疗,对照组采用持续气道正压通气(continuous positive airway pressure,CPAP),观察组采用双水平气道正压通气(Bi-level positive airway pressure,BiPAP),比较两组患者的临床疗效、血气分析、血流动力学、Tei心功能指数等指标变化。结果观察组治疗有效率为85.00%,与对照组的82.50%相比,差异无统计学意义(P>0.05);两组治疗12 h后HR、RR较治疗前明显降低,而PaO_2、SaO_2、PaO_2/FiO_2较治疗前明显升高,差异有统计学意义(P<0.05),但两组间治疗后无明显差异(P>0.05);两组治疗12 h后MAP、CO、SVR与治疗前相比均明显改善(P<0.05),但两组治疗后相比无明显差异(P>0.05);观察组治疗后6 h、12 h、24 h的心功能指数与对照组相比无明显差异(P>0.05)。结论 CPAP和BiPAP两种无创通气模式治疗急性左心衰竭均有良好效果,能有效缓解低氧血症,减轻心脏前后负荷,改善肺通气和换气功能,但BiPAP模式的使用舒适性更高,临床可根据实际情况选择。

Objective To investigate the effect of two noninvasive ventilation modes in the treatment of acute left heartfailure. Methods 80 patients with acute left heart failure who were treated in the emergency department of our hospitalfrom November 2016 to November 2017 were divided into two groups according to the non-invasive ventilation modes.All patients were given conventional medications. The control group was given continuous positive airway pressure（CPAP）, and the observation group was given Bi-level positive airway pressure（BiPAP）. Changes in the clinical efficacy,blood gas analysis, hemodynamics, and Tei heart function index were compared between the two groups. Results Thetreatment effective rate in the observation group was 85.00%, and compared with 82.50% in the control group, the difference was not statistically significant（P〉0.05）; after 12 hours of treatment, HR, RR were significantly lower than thosebefore treatment. PaO2, SaO2, PaO2/FiO2 were significantly higher than those before treatment in both groups, and thedifferences were statistically significant（P〈0.05）. There was no significant difference between the two groups aftertreatment（P〉0.05）; after 12 hours of treatment, MAP, CO and SVR were significantly improved compared with thosebefore treatment（P〈0.05）. However, there was no significant difference between the two groups after treatment （P〉0.05）;there was no significant difference in heart function index in the observation group at 6 h, 12 h and 24 h after treatment（P〉0.05）. Conclusion Both the two non-invasive ventilation modes of CPAP and BiPAP have a favorable effect inthe treatment of acute left heart failure, which can effectively alleviate hypoxemia, reduce the load before and after theheart, and improve lung ventilation and exchange. However, the BiPAP mode is more comfortable to use and can be selected clinically according to the actual situation.