无创通气在拒绝气管插管急性左心衰竭患者治疗中的临床应用价值

Evaluation of the clinical application of noninvasive ventilation in patients with acute left heart failure refusing endotracheal intubation

目的探讨无创通气在拒绝气管插管急性左心衰竭患者治疗中的临床应用价值。方法选择浙江省绍兴第二医院2017年9月至2020年9月收治的急性左心衰竭患者60例为研究对象,按治疗方法分为试验组和对照组,每组30例,对照组患者在常规治疗基础上加用氧疗,试验组患者在常规治疗基础上联合无创通气支持治疗。比较两组患者的临床疗效、pH值、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、呼吸频率(RR)、心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(SaO_(2))及不良反应发生情况。结果试验组治疗后总有效率高于对照组[86.67%(26/30)比63.33%(19/30)],差异有统计学意义(χ^(2)=15.864,P<0.05)。治疗后1、4 h,试验组pH值和PaO_(2)均高于对照组[治疗后1 h:7.69±0.79比7.27±0.74、(77.91±8.94)mmHg(1 mmHg=0.133kPa)比(69.27±8.03)mmHg;治疗后4 h:7.83±0.81比7.38±0.84、(97.35±11.23)mmHg比(85.87±9.76)mmHg],而PaCO_(2)低于对照组[治疗后1 h:(49.27±6.53)mmHg比(53.18±6.86)mmHg;治疗后4 h:(43.35±5.75)mmHg比(47.89±6.26)mmHg],差异均有统计学意义(P<0.05)。试验组患者治疗后1、4 h RR、HR、MAP及SaO_(2)均低于对照组[治疗后1 h:(21.93±3.46)次/min比(26.83±3.57)次/min、(95.85±10.48)次/min比(111.92±18.35)次/min、(132.93±16.73)mmHg比(142.74±17.95)mmHg、0.422±0.057比0.468±0.051;治疗后4 h:(18.74±2.34)次/min比(24.14±3.62)次/min、(90.88±9.56)次/min比(151.21±19.03)次/min、(123.83±15.82)mmHg比(136.74±16.92)mmHg、0.333±0.047比0.389±0.049],差异有统计学意义(P<0.05);试验组患者总并发症发生率低于对照组[33.33%(10/30)比10.00%(3/30)],差异有统计学意义(χ^(2)=4.812,P=0.028)。结论无创通气在拒绝气管插管急性左心衰竭患者治疗中疗效确切,不仅可改善其血气分析指标,还可纠正缺氧现象,安全性高,能有效避免患者病情恶化。

Objective To evaluate the clinical value of noninvasive ventilation in the treatment of patients with acute left heart failure refusing endotracheal intubation.Methods A total of 60 patients with acute left heart failure admitted to Shaoxing Second Hospital from September 2017 to September 2020 were selected as study subjects and were divided into the experimental group and the control group by different treatment methods,with 30 patients in each group.Patients in the control group were treated with oxygen therapy on the basis of conventional drug therapy,and patients in the experimental group were treated with non-invasive ventilation support therapy on the basis of conventional treatment.The clinical efficacy,pH value,partial pressure of carbon dioxide(PaCO_(2)),partial pressure of oxygen(PaO_(2)),respiratory rate(RR),heart rate(HR),mean arterial pressure(MAP),terminal oxygen saturation(SaO_(2))and adverse reactions were compared between the two groups.Results The total effective rate in the experimental group was higher than that in the control group:86.67%(26/30)vs.63.33%(19/30),and the difference was statistically significant(χ^(2)=15.864,P<0.05).At 1 and 4 h after treatment,the levels of pH value and PaO_(2) in the experimental group were higher than those in the control group:after treatment 1 h:7.69±0.79 vs.7.27±0.74,(77.91±8.94)mmHg(1 mmHg=0.133 kPa)vs.(69.27±8.03)mmHg;after treatment 4 h:7.83±0.81 vs.7.38±0.84,(97.35±11.23)mmHg vs.(85.87±9.76)mmHg;however,PaCO_(2) was lower than those in the control group:after treatment 1 h:(49.27±6.53)mmHg vs.(53.18±6.86)mmHg;after treatment 4 h:(43.35±5.75)mmHg vs.(47.89±6.26)mmHg,and the differences were statistically significant(P<0.05).At 1 and 4 h after treatment,the levels of RR,HR,MAP and SaO_(2) in the experimental group were lower than those in the control group:after treatment 1h:(21.93±3.46)times/min vs.(26.83±3.57)times/min,(95.85±10.48)beats/min vs.(111.92±18.35)beats/min,(132.93±16.73)mmHg vs.(142.74±17.95)mmHg,0.422±0.057 vs.0.468±0.051;after treatment 4 h:(18.74±2.34)times/min vs.(24.14±3.62)times/min,(90.88±9.56)beats/min vs.(151.21±19.03)beats/min,(123.83±15.82)mmHg vs.(136.74±16.92)mmHg,0.333±0.047 vs.0.389±0.049,and the differences were statistically significant(P<0.05).The incidence of total complications in the experimental group was lower than that in the control group:33.33%(10/30)vs.10.00%(3/30),the difference was statistically significant(χ^(2)=4.812,P=0.028).Conclusions Noninvasive ventilation is effective in the treatment of patients with acute left heart failure who refuse endotracheal intubation.It can not only improve the blood gas analysis index,but also correct the hypoxia phenomenon.It is highly safe and can effectively avoid the deterioration of patients′condition.