BiPAP无创机械通气对COPD合并急性左心衰竭患者心肺功能及血流动力学的影响

Effects of BiPAP non-invasive mechanical ventilation on cardiopulmonary function and hemodynamics in patients with COPD complicated with acute left heart failure

目的探究双水平气道正压无创机械通气(BiPAP)对慢性阻塞性肺疾病(COPD)合并急性左心衰竭患者的影响。方法前瞻性选取于我院就诊的114例COPD合并急性左心衰竭患者为研究对象,并经抽签法随机分为观察组(常规药物联合BiPAP无创机械通气,57例)及对照组(常规药物治疗,57例)。于治疗1个月后评估两组患者临床疗效,比较治疗前、治疗1个月后其心功能、肺通气[呼吸道总阻力(R_(5))、中心呼吸道阻力(R_(20))、周边呼吸道阻力(R_(5)-R_(20))]、血气水平、血流动力学[血流量(BF)、血流速度(BV)]的变化。结果治疗1个月后,观察组[CO(58.38±5.34)mL、SpO_(2)(95.69±0.41)%、PaO_(2)(66.27±3.41)mmHg、BF(44.65±7.11)mL/min、BV(24.47±4.41)cm/s]均显著高于对照组的[CO(54.87±4.59)mL、SpO_(2)(92.76±0.35)%、PaO_(2)(62.42±3.07)mmHg、BF(40.76±6.78)mL/min、BV(22.62±4.07)cm/s](P<0.05);观察组治疗1个月后[LVESD(39.53±2.06)mm、LVEDD(50.22±2.13)mm、R_(5)(0.77±0.14)[kpa/(L·s)]、R_(20)(0.48±0.09)[kpa/(L·s)]、R_(5)-R_(20)(0.28±0.06)[kpa/(L·s)]、PaCO_(2)(47.32±3.28)mmHg]显著低于对照组的[LVESD(43.48±2.23)mm、LVEDD(53.60±2.36)mm、R_(5)(0.92±0.18)[kpa/(L·s)]、R_(20)(0.52±0.11)[kpa/(L·s)]、R_(5)-R_(20)(0.34±0.09)[kpa/(L·s)]、PaCO_(2)(50.22±3.38)mmHg],差异有统计学意义(P<0.05)。观察组治疗1个月后,其临床疗效显著高于对照组(47.37%vs.28.08%,P<0.05)。结论采用BiPAP无创机械通气治疗对于COPD合并急性左心衰竭患者的临床应用效果较好,可明显提高患者心、肺通气功能,缓解其缺氧状态。

Objective To explore the effects of bi-level positive airway pressure(BiPAP)combined with spironolactone on patients with chronic obstructive pulmonary disease(COPD)complicated with acute left heart failure.Methods 114 patients with COPD complicated with acute left heart failure who were treated in the hospital were prospectively selected as the research subjects,and they were randomly divided into observation group(conventional drug combined with BiPAP non-invasive mechanical ventilation,57 cases)and control group(conventional drug treatment,57 cases)by lottery method.The clinical efficacy in the two groups was evaluated after 1 month of treatment.The cardiac function,pulmonary ventilation[total airway resistance(R_(5)),central airway resistance(R_(20)),peripheral airway resistance(R_(5)-R_(20))],blood gas indicators and hemodynamics[blood flow(BF),blood flow velocity(BV)]were compared between the two groups before treatment and after 1 month of treatment.Results After 1 month of treatment,TheCO,SpO_(2),PaO_(2),BFandBVwere(58.38±5.34)mL,(95.69±0.41)%,(66.27±3.41)mmHg,(44.65±7.11)mL/minand(24.47±4.41)cm/s in observation group were significantly higher than(54.87±4.59)mL,(92.76±0.35)%,(62.42±3.07)mmHg,(40.76±6.78)mL/min and(22.62±4.07)cm/s in control group(P<0.05).The LVESD,LVEDD,R_(5),R_(20),R_(5)-R_(20)and PaCO_(2)were(39.53±2.06)mm,(50.22±2.13)mm,(0.77±0.14)kpa/(L·s),(0.48±0.09)kpa/(L·s),(0.28±0.06)kpa/(L·s)and(47.32±3.28)mmHg in observation group after 1 month of treatment were significantly lower than(43.48±2.23)mm,(53.60±2.36)mm,(0.92±0.18)[kpa/(L·s)],(0.52±0.11)[kpa/(L·s)],(0.34±0.09)[kpa/(L·s)]and(50.22±3.38)mmHg in control group(P<0.05).After 1 month of treatment,the clinical efficacy in observation group was significantly higher than that in control group(47.37%vs.28.08%,P<0.05).Conclusion The use of BiPAP non-invasive mechanical ventilation in addition to conventional medication treatment has a better clinical application effect for patients with COPD complicated by acute left heart failure.It can significantly improve the cardiac and pulmonary ventilation function of patients and alleviate their oxygendeficiencystate.