呼吸支持在急诊酮症酸中毒昏迷合并急性左心衰患者救治中的应用分析

Application Analysis of Respiratory Support in the Treatment of Emergency Patients with Ketoacidosis Coma Complicated with Acute Left Heart Failure

目的:分析呼吸支持在急诊酮症酸中毒昏迷合并急性左心衰患者救治中的应用效果。方法:回顾性分析2019年1月-2020年12月本院急诊科收治的120例酮症酸中毒昏迷合并急性左心衰患者临床资料,依据治疗方法分为鼻导管给氧组、无创压力支持通气组、成比例辅助通气组,每组40例。鼻导管给氧组采取鼻导管高流量给氧治疗,无创压力支持通气组采取无创压力支持通气治疗,成比例辅助通气组采取成比例辅助通气治疗。比较气管插管率和死亡率;比较三组治疗前和治疗6 h的血气指标和生命体征。结果:鼻导管给氧组气管插管率、死亡率均高于无创压力支持通气组和成比例辅助通气组,差异均有统计学意义(P<0.05)。治疗前,三组动脉二氧化碳分压、动脉血氧分压、动脉血氧饱和度、呼吸、心率、平均动脉压比较,差异均无统计学意义(P>0.05);治疗6 h,三组动脉二氧化碳分压、动脉血氧分压、动脉血氧饱和度、呼吸、心率、平均动脉压均优于治疗前,且鼻导管给氧组均差于无创压力支持通气组和成比例辅助通气组,差异均有统计学意义(P<0.05)。无创压力支持通气组与成比例辅助通气组的插管率、死亡率、动脉二氧化碳分压、动脉血氧分压、动脉血氧饱和度、呼吸、心率、平均动脉压比较,差异均无统计学意义(P>0.05)。结论:在急诊酮症酸中毒昏迷合并急性左心衰患者救治中呼吸支持有助于降低患者死亡率,改善血气指标及生命体征指标,且无创压力支持通气与成比例辅助通气效果相当。

Objective:To analyze the effect of respiratory support in the treatment of emergency patients with ketoacidosis coma complicated with acute left heart failure.Method:The clinical data of 120 patients with ketoacidosis coma complicated with acute left heart failure admitted to the emergency department of our hospital from January 2019 to December 2020 were retrospectively analyzed,and they were divided into nasal catheter oxygenation group,non-invasive pressure support ventilation group and proportional assisted ventilation group according to therapeutic method,40 cases in each group.The nasal catheter oxygenation group was treated with nasal catheter high-flow oxygen therapy,the non-invasive pressure support ventilation group was treated with non-invasive pressure support ventilation,and the proportional assisted ventilation group was treated with proportional assisted ventilation.The rate of endotracheal intubation and mortality were compared.Blood gas indexes and vital signs before treatment and 6 h of treatment were compared among three groups.Result:The rate of endotracheal intubation and mortality in nasal catheter oxygenation group were higher than those in non-invasive pressure support ventilation group and proportional assisted ventilation group,the differences were statistically significant (P<0.05).Before treatment,there were no significant differences in arterial partial pressure of carbon dioxide,arterial partial pressure of oxygen,arterial oxygen saturation,respiration,heart rate and mean arterial pressure among three groups (P>0.05);6 h of treatment,arterial partial pressure of carbon dioxide,arterial partial pressure of oxygen,arterial oxygen saturation,respiration,heart rate and mean arterial pressure in three groups were better than those before treatment,and those in the nasal catheter oxygenation group were worse than non-invasive pressure support ventilation group and proportional assisted ventilation group,the differences were statistically significant (P<0.05).There were no significant differences in intubation rate,mortality,arterial partial pressure of carbon dioxide,arterial partial pressure of oxygen,arterial oxygen saturation,respiration,heart rate and mean arterial pressure between the non-invasive pressure support ventilation group and the proportional auxiliary ventilation group (P>0.05).Conclusion:In the treatment of emergency patients with ketoacidosis coma complicated with acute left heart failure,respiratory support can help reduce the mortality of patients,improve blood gas indicators and vital signs,and non-invasive pressure support ventilation has the same effect as proportional assisted ventilation.