有创机械通气治疗ICU重症心力衰竭的疗效分析

Analysis of therapeutic effect of invasive mechanical ventilation on ICU patients with severe heart failure

目的分析有创机械通气治疗重症加强护理病房(ICU)重症心力衰竭患者的效果。方法选择68例ICU重症心力衰竭患者为研究对象,随机分为研究组与对照组,各34例。对照组在常规治疗基础上采用高流量经鼻导管吸氧,研究组在常规治疗基础上接受有创机械通气。比较两组血气指标[动脉血氧分压(PaO_(2))、经皮血氧饱和度(SpO_(2))、动脉血二氧化碳分压(PaCO_(2))]、血流动力学指标[血管外肺水指数(EVLWI)、全心舒张末期容积指数(GEDVI)与心功能指数(CFI)]、心肌损伤标志物[氨基末端脑钠肽前体(NT-proBNP)与心肌肌钙蛋白T(cTnT)]及临床疗效。结果研究组与对照组基线PaO_(2)、SpO_(2)与PaCO_(2)比较无统计学差异(P>0.05)。治疗后48 h,研究组PaO_(2)、SpO_(2)显著高于对照组(P<0.05);两组PaCO_(2)比较无统计学差异(P>0.05)。两组基线EVLWI、GEDVI与CFI比较均无统计学差异(P>0.05)。治疗后48 h,两组EVLWI、GEDVI与CFI较基线差异显著,且研究组EVLWI低于对照组,GEDVI、CFI则高于对照组(P<0.05)。两组基线血清NT-proBNP与cTnT比较无统计学差异(P>0.05)。治疗后48 h,研究组NT-proBNP(1521.6±851.4)pg/ml与cTnT(0.9±0.4)μg/L均明显低于对照组的(2041.2±912.9)pg/ml、(1.8±0.7)μg/L(P<0.05)。研究组总有效率97.1%显著高于对照组的76.5%(P<0.05)。结论有创机械通气治疗ICU重症心力衰竭患者,可提升治疗效果,促进患者血气、血流动力学改善,降低心肌损伤情况。

Objective To analyze the effect of invasive mechanical ventilation on intensive care unit(ICU)patients with severe heart failure.Methods 68 ICU patients with severe heart failure were selected and randomly divided into a study group and a control group,with 34 cases in each group.The control group received with oxygen inhalation through a high-flow nasal catheter on the basis of conventional treatment,while the study group received invasive mechanical ventilation on the basis of conventional treatment.Both groups were compared in terms of blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),percutaneous arterial oxygen saturation(SpO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2))],hemodynamic indexes[extravascular lung water index(EVLWI),global end-diastolic volume index(GEDVI)and cardiac function index(CFI)],markers of myocardial injury[N-terminal pro-brain natriuretic peptide(NT-proBNP)and cardiac troponin T(cTnT)],and clinical efficacy.Results There were no significant differences in baseline PaO_(2),SpO_(2) and PaCO_(2) between the study group and the control group(P>0.05).At 48 h after treatment,PaO_(2) and SpO_(2) of the study group were significantly higher than those of the control group(P<0.05).There was no statistical difference in PaCO_(2) between the two groups(P>0.05).There was no statistical difference in baseline EVLWI,GEDVI and CFI between the two groups(P>0.05).At 48 h after treatment,EVLWI,GEDVI and CFI of the two groups were significantly different from baseline,and EVLWI of the study group was lower than that of the control group,while GEDVI and CFI of the control group were higher(P<0.05).There was no significant difference between baseline serum NT-proBNP and cTnT between the two groups(P>0.05).At 48 h after treatment,the study group had NT-proBNP of(1521.6±851.4)pg/ml and cTnT of(0.9±0.4)μg/L,which were significantly lower than(2041.2±912.9)pg/ml and(1.8±0.7)μg/L in the control group(P<0.05).The total effective rate of the study group was 97.1%,which was significantly higher than 76.5%of the control group(P<0.05).Conclusion Invasive mechanical ventilation in ICU patients with severe heart failure can improve the therapeutic effect,promote the improvement of blood gas and hemodynamics,and reduce myocardial damage.