利尿药物联合无创正压通气治疗慢性肺源性心脏病急性发作的临床评价

Clinical evaluation of diuretics combined with non-invasive positive pressure ventilation in the treatment of acute exacerbation of chronic pulmonary heart disease

目的探讨利尿药物联合无创正压通气治疗慢性肺源性心脏病(下称肺心病)急性发作的临床效果。方法选择2019年1月至2021年10月温州医科大学附属衢州医院收治的慢性肺心病急性发作的患者92例,按病案号奇偶数分为观察组和对照组,各46例。两组在常规治疗的基础上,对照组给予无创正压通气,观察组给予无创正压通气联合利尿药物。比较两组患者疗效、康复进程(咳嗽缓解时间、呼吸困难缓解时间、下肢水肿消失时间、体力恢复时间、住院时间)、呼吸功能及血气分析[用力肺活量(FVC)、第1秒用力呼气容积占FVC比值(FEV_(1)/FVC)、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))]、右心结构及功能指标[右心室舒张末期横径(RVTD)/左心室横径(LVTD)、三尖瓣环收缩期位移(TAPSE)、右心室面积变化分数(FAC)、肺动脉收缩压(PASP)、右心室流出道内径(RVOT)]、左心结构及功能指标[左心房内径(LAD)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVESd)、左心室射血分数(LVEF)]、不良反应发生率。结果观察组总有效率为95.65%,高于对照组的82.61%(P<0.05);观察组呼吸困难缓解时间、下肢水肿消失时间、体力恢复时间、住院时间均短于对照组(均P<0.01);观察组治疗后PaO_(2)高于对照组,PaCO_(2)低于对照组(均P<0.05);观察组治疗后RVTD/LVTD、PASP、RVOT、LAD、LVEDd、LVESd均低于对照组,TAPSE、FAC、LVEF均高于对照组(均P<0.05);观察组不良反应发生率为6.52%(3/46),与对照组2.17%(1/46)比较,差异无统计学意义(P>0.05)。结论利尿药物联合无创正压通气治疗慢性肺心病急性发作,可提高疗效,加快患者康复进程,改善呼吸功能和心功能,具有一定安全性。

Objective To investigate the clinical effect of diuretics combined with non-invasive positive pressure ventilation(NIPPV)in the treatment of acute exacerbation of chronic pulmonary heart disease(CPHD).Methods A total of 92 patients with acute exacerbation of CPHD from January 2019 to October 2021 in Quzhou Hospital Affiliated to Wenzhou Medical University were enrolled and randomly divided into an observation group and a control group(with 46 cases in each group).On the basis of routine treatment,the control group was given NIPPV,and the observation group was given NIPPV with diuretics.The curative effect,rehabilitation process,respiratory function and blood gas parameters,end diastolic right ventricular transaction diameter(RVTD)/left ventricular transaction diameter(LVTD),tricuspid annular plane systolic excursion(TAPSE),right ventricular fractional area change(FAC),pulmonary artery systolic pressure(PASP),right ventricular outflow tract(RVOT),left atrial diameter(LAD),left ventricular end diastolic diameter(LVEDd),left ventricular end-systolic diameter(LVESd),left ventricular ejection fraction(LVEF)and occurrence of adverse reaction were compared between the groups.Results The total effective rate of the observation group was 95.65%,significantly higher than 82.61%of the control group(P<0.05).The time to dyspnea relief,lower extremity edema relief,physical recovery,and the length of hospital stay in the observation group were significantly lower than those of the control group(all P<0.01).After treatment,arterial partial pressure of oxygen in the observation group was significantly higher than that in the control group,and arterial partial pressure of carbon dioxide was lower than that in the control group(all P<0.05).RVTD/LVTD,PASP,RVOT,LAD,LVEDd and LVESd in the observation group after treatment were significantly lower than those in the control group,and TAPSE,FAC and LVEF were higher than those in the control group(all P<0.05).The incidence of adverse reactions in the observation group was 6.52%(3/46),compared with 2.17%(1/46)in the control group,with no significant difference(P>0.05).Conclusion Diuretics combined with NIPPV in the treatment of acute exacerbation of CPHD can improve curative effect,recovery process,respiratory and cardiac function.