BiPAP无创正压通气对急性心力衰竭伴呼吸衰竭患者HRV、心肺功能的影响

Effect of BiPAP on HRV and cardiopulmonary function in patients with acute heart failure and respiratory failure

目的探究双水平气道正压通气(BiPAP)对急性心力衰竭(AHF)伴呼吸衰竭(RF)患者心率变异性(HRV)、心肺功能的影响。方法选择西部战区总医院急诊学科抢救室2020年10月—2021年10月期间收治入院的155例AHF伴RF患者,按照随机数字表法分为BiPAP组(n=77)和CPAP组(n=78),比较两组患者症状改善情况、HRV及心肺功能。结果两组AHF伴RF患者均无死亡,ICU住院时间、无创通气时间、症状缓解时间、插管率差异均无统计学意义(P>0.05)。治疗前,两组AHF伴RF患者正常心脏搏动周期(RR)间期标准差(SDNN)、RR间期平均值标准差(SDANN)、相邻心跳连续差均方根(RMSSD)、低频功率(LF)、高频功率(HF)、左心室射血分数(LVEF)、心输排血(CO)、心脏指数(CI)、每搏输出量(SV)、动脉血氧分压(PaO_(2))、血氧饱和度(SaO_(2))、动脉血二氧化碳分压(PaCO_(2))差异均无统计学意义(P>0.05);治疗后,BiPAP组SDNN、SDANN、RMSSD、LF、HF、LVEF、CO、CI、SV、PaO_(2)、SaO_(2)均上升,CPAP组RMSSD较治疗前无变化,其余均上升,两组PaCO_(2)均下降,BiPAP组SDNN、SDANN、RMSSD、LF、HF、PaO_(2)、SaO_(2)高于CPAP组(P<0.05),PaCO_(2)低于CPAP组(P<0.05),两组间LVEF、CO、CI、SV差异无统计学意义(P>0.05)。结论BiPAP、CPAP均能显著改善AHF伴RF患者的临床症状、HRV和心肺功能,但BiPAP对HRV和肺功能的改善效果更显著。

Objective To investigate the effect of bilevel positive airway pressure(BiPAP)on heart rate variability(HRV)and cardiopulmonary function in patients with acute heart failure(AHF)and respiratory failure(RF).Methods A total of 155 patients with AHF and RF who were admitted to the department of emergency medicine of the hospital from October 2020 to October 2021 were selected,and assigned to BiPAP group(n=77)and CPAP group(n=78)by random number table method.Symptom improvement,HRV,and cardiopulmonary function were compared between the two groups.Results There was no statistically significant difference between the two groups in death,length of ICU stay,non-invasive ventilation time,symptom relief time and intubation rate(P>0.05).There was no statistically significant difference between the two groups in the standard deviation of normal-to-normal RR intervals(SDNN),the standard deviation of the averages of RR intervals(SDANN),the root mean square of successive differences(RMSSD),low frequency(LF),high frequency(HF),left ventricular ejection fraction(LVEF),cardiac output(CO),cardiac index(CI),stroke volume(SV),arterial partial pressure of oxygen(PaO_(2)),blood oxygen saturation(SaO_(2))and arterial partial pressure of carbon dioxide(PaCO_(2))before treatment(P>0.05).After treatment,SDNN,SDANN,RMSSD,LF,HF,LVEF,CO,CI,SV,PaO_(2) and SaO_(2) were increased in BiPAP group.There was no change of RMSSD,and the rest indicators were increased in CPAP group.PaCO_(2) was decreased in the two groups.SDNN,SDANN,RMSSD,LF,HF,PaO_(2) and SaO_(2) in BiPAP group were higher than those in CPAP group(P<0.05).There was no statistically significant difference in LVEF,CO,CI or SV between the two groups(P>0.05).Conclusion Both BiPAP and CPAP can significantly improve the clinical symptoms,HRV and cardiopulmonary function in patients with AHF and RF.However,BiPAP is more efective in improving HRV and pulmonary function.