无创呼吸机治疗保留射血分数急性左心心力衰竭患者疗效观察

Clinical effect of noninvasive ventilator in the treatment of acute left heart failure with preserved ejection fraction

目的研究无创呼吸机治疗保留射血分数急性左心心力衰竭患者的临床疗效。方法选取2018年6月至2020年2月在广东省人民医院南海医院经检查确诊为保留射血分数急性左心心力衰竭的92例患者为研究对象,采用随机数表法将患者分为观察组和对照组,每组46例。对照组采用药物及对症处理等常规治疗,观察组在常规治疗的基础上使用无创呼吸机治疗,疗程为14 d。治疗两周后,比较两组患者的治疗效果,以及治疗前后的心率(HR)、氧饱和度(SaO2)、呼吸频率(R)动脉血二氧化碳分压(PaCO2)、血氧分压(PaO2);同时比较两组患者治疗前及治疗24 h后的心肌钙蛋白I(cTnI)、脑钠肽(NT-pro BNP)水平;比较两组患者并发症发生情况。结果观察组患者的治疗总有效率为91.30%,明显高于对照组的60.87%,差异有统计学意义(P<0.05);治疗后,观察组和对照组患者的SaO2[(93.24±12.17)%vs(82.16±11.24)%]、PaO2[(80.15±13.26)mmHg vs(61.17±11.16)mmHg]比较,观察组明显高于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的PaCO2[(37.79±5.14)mmHg vs(41.09±5.62)mmHg]、HR[(109.51±17.94)次/min vs(136.38±14.47)次/min、R[(30.41±11.33)次/min vs(40.31±12.48)次/min]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组和对照组患者的cTnI[(4.59±1.37)ng/mL vs(5.73±1.29)ng/mL]、NT-pro BNP[(511.37±79.52)pg/mL vs(594.19±85.22)pg/mL]比较,观察组明显低于对照组,差异均有统计学意义(P<0.05);观察组患者的并发症总发生率为6.52%,明显低于对照组20.08%,差异有统计学意义(P<0.05)。结论无创呼吸机可有效改善保留射血分数急性左心心力衰竭患者的心功能状况及血气指标,有效降低并发症发生,临床治疗效果显著,值得推广应用。

Objective To study the clinical effect of noninvasive ventilator in the treatment of acute left heart failure with preserved ejection fraction.Methods From June 2018 to February 2020,92 patients with acute left heart failure with preserved ejection fraction diagnosed in Nanhai Hospital of Guangdong People's Hospital were analyzed.According to the use of noninvasive ventilator,the patients were divided into the observation group and control group,with 46 patients in each group.The control group was treated with drugs and symptomatic treatment,while the observation group was treated with noninvasive ventilator on the basis of conventional treatment.The course of treatment was 14 days.After two weeks of treatment,the therapeutic effects of the two groups were compared.After two weeks of treatment,the heart rate(HR),oxygen saturation(SaO2),respiratory rate(R),arterial partial pressure of carbon dioxide(PaCO2)and partial pressure of oxygen(PaO2)were compared before and after treatment;the levels of cardiac troponin I(cTnI)and brain natriuretic peptide(NT-Pro BNP)were compared before and 24 hours after treatment;the complications of the two groups were compared.Results After treatment,the total effective rate of the observation group was 91.30%,which was significantly higher than 60.87%of the control group(P<0.05);after treatment,SaO2 and PaO2 in the observation group were(93.24±12.17)%and(80.15±13.26)mmHg,which were significantly higher than corresponding(82.16±11.24)%and(61.17±11.16)mmHg in the control group(P<0.05);PaCO2,HR,R in the observation group were(37.79±5.14)mmHg,(109.51±17.94)times/min,(30.41±11.33)times/min,respectively,which were significantly lower than corresponding(41.09±5.62)mmHg,(136.38±14.47)times/min,(40.31±12.48)times/min in the control group(all P<0.05);cTnI and NT-pro BNP in the observation group were(4.59±1.37)ng/mL and(511.37±79.52)pg/mL,significantly lower than corresponding(5.73±1.29)ng/mL and(594.19±85.22)pg/mL in the control group(P<0.05);after treatment,the total incidence of complications in the observation group was 6.52%versus 20.08%in the control group(P<0.05).Conclusion Noninvasive ventilator can effectively improve the cardiac function and blood gas index of patients with acute left heart failure,effectively reduce the incidence of complications,and has significant clinical treatment effect,which is worth popularizing.