无创呼吸机在80岁以上高龄急性左心衰竭患者中的应用

Application of noninvasive ventilator in elderly patients over 80 years old with acute heart failure

目的 探讨80岁以上高龄急性左心衰竭患者临床特点以及应用无创呼吸机治疗的安全性和有效性.方法 连续入选于我院心脏中心诊断为失代偿期心力衰竭,住院期间发作急性左心衰竭且能耐受无创呼吸机治疗患者65例,根据年龄分为高龄组(年龄≥80岁,20例)和对照组(年龄<80岁,45例).对比两组患者入院时基本情况、急性左心衰竭时血气分析、基本生命体征等临床资料以及应用无创呼吸机前后指标变化.结果 比较两组基线资料发现,高龄组合并冠心病比例,N末端B型利钠肽前体(NT-proBNP)水平明显高于对照组(P<0.05).两组患者应用呼吸机前临床体征及血气分析的差异无明显统计学意义(P均>0.05).应用呼吸机治疗2 h后,两组患者收缩压,心率,乳酸水平均有明显下降,而动脉血氧饱和度(SaO2)水平均有明显上升(P均<0.05).应用呼吸机治疗48 h后,两组患者左心房直径,肺动脉压力水平均有所下降,左心室射血分数(LVEF)明显上升(P均<0.05).对照组NT-proBNP水平明显下降[(10007.48±2183.22)ng/L比(4342.82±270.78)ng/L,P=0.001],而高龄组患者NT-proBNP变化无统计学意义(P>0.05).高龄组收缩压下降程度小于对照组[(-18.05±3.01)mmHg(1 mmHg=0.133 kPa)比(-31.02±5.16)mmHg,P=0.036].两组患者应用呼吸机过程中均无死亡病例,但高龄组应用无创呼吸机时间长于对照组[(116.61±15.18)h比(102.62±13.67)h,P=0.043].结论 应用无创呼吸机治疗可以改善高龄患者氧合状态,降低乳酸水平,改善心脏功能.但是高龄组患者应用时间长于对照组,且48 h NT-proBNP未见明显下降,提示80岁以上高龄患者应用无创通气后达到临床缓解所需时间可能更长.

Objective To investigate the clinical features of acute left heart failure in elderly patients over 80 years old and the safety and efficacy of noninvasive ventilator .Methods Sixty-five patients with a diagnosis of decompensated heart failure and were hospitalized with acute left heart failure and were able to tolerate noninvasive ventilator during hospitalization were enrolled consecutively in our study .The patients were divided into the elderly group ( age ≥80 years, n =20 ) and the control group ( age <80 years, n=45).The baseline data of hospital admission , blood gas analysis of acute left heart failure , vital signs and other clinical data were recorded before and after the application of noninvasive ventilator and were compared between the two groups .Results Compared the baseline data between the two groups , we found the prevalence of coronary heart disease was higher in the elderly group (P<0.05).There was no significant difference in the vital signs before the application of noninvasive ventilator between the two groups .( All P>0.05).After 2 hours application of the ventilator , we found the systolic blood pressure , heart rate, and the lactate level decreased significantly in both groups , while the SaO2 value increased significantly.(All P<0.05).After 48 hours application of the ventilator , we found the left atrium diameter (LA), the pulmonary artery pressure ( PAP) were significantly decreased in both groups while the left ventricular ejection fraction (LVEF) increased significantly (All P<0.05).The NT-proBNP value significantly decreased in the control group [(10007.48 ±2183.22)ng/L vs(4342.82 ±270.78)ng/L,P=0.001].In contrast, the decrease of NT-proBNP value in the elderly group was not significant (P>0.05).Compared the data changed before and after the non-invasive ventilation in both groups , we found the degree of systolic blood pressure decreased were lower in the elderly group than those in the control group [ ( -18.05 ±3.01 ) mmHg (1 mmHg=0.133 kPa) vs ( -31.02 ±5.16) mmHg, P=0.036].No deaths occurred in both groups, while the duration of non-invasive ventilation was longer in the elderly than those in the control group [(116.61 ±15.18) h vs (102.62 ±13.67) h, P=0.043].Conclusions The application of noninvasive ventilation in the elderly patients with acute heart failure was able to improve the oxygenation status ,cardiac function and lower the lactate levels .However , patients in the elder group had longer application time than those in the control group , and there was no significant decrease in NT-proBNP at 48 hours, suggesting that patients aged more than 80 years needed more time to achieve clinical remission .