有创机械通气治疗急性重度左心衰竭患者的疗效及预后影响因素分析  

作　　者：李树[1] 李凤杰[1] 金爱春[1] 刘福军[1] 

机构地区：[1]北京市首都医科大学潞河教学医院,北京101149

出　　处：《当代医药论丛》2014年第1期86-87,共2页

摘　　要：目的:探讨有创机械通气治疗急性重度左心衰竭的疗效,分析治疗后导致患者死亡的危险因素。方法:选择明确诊断为急性重度左心衰竭,需行有创机械通气治疗的107例患者,根据是否生存将其分为生存组与死亡组,比较两组的性别、年龄、合并疾病、血压、心率、呼吸、动脉血气分析PaO2、PaCO2、乳酸值。结果:本组107例患者,生存69例,死亡38例,死亡率达35.51%;急性冠脉综合征所致急性左心衰竭的死亡率更高,达50%。与生存组相比,死亡组机械通气开始时收缩压低([108.58±29.38)mmHg v(s122.47±27.34)mmHg,P<0.05]、舒张压低([61.83±23.16)mmHg v(s73.56±17.34)mmHg),P<0.05]、动脉血pH值低(7.10±0.12 vs7.29±0.12,P<0.05)、PaO2低([53.41±6.02)mmHg vs(59.41±4.02)mmHg,P<0.05],PaCO2高([50.73±5.91)mmHg vs(40.73±5.91)mmHg,P<0.05]、乳酸值高([3.97±3.76)mmol/L vs(2.26±1.17)mmol/L,P<0.05],且差异有统计学意义。结论:行有创机械通气治疗的急性重度左心衰竭患者死亡率高,死亡组患者的血压、动脉血pH值、PaO2均低于生存组,PaCO2、乳酸值则高于生存组。Objective:To determine prognostic factors associated with death in patients with acute severe left heart failure requiring invasive mechanical ventilation. Methods:A total of 107 consecutive patients with acute severe left heart failure requiring invasive mechanical ventilationwere divided into survival group and nonsurvival group. When mechanical ventilation was applied, the initial data about sex ratio, age,complicated diseases, blood pressure, heart rate, respiratory rate and PaO2, PaCO2 and lactate value were compared between the two group. Results:The mortality rate was 35.51%. The nonsurvival group and the survival group had the similar sex ratio, age, complicated diseases, initial heart rate and respiratory rate. Nonsurvival group had lower systolic blood pressure([108.58±29.38)mmHg v(s122.47±27.34)mmHg, P<0.05], lower systolic diastolic blood pressure([61.83±23.16)mmHg v(s73.56±17.34)mmHg), P<0.05], lower arterial blood pH value(7.10±0.12 vs7.29±0.12, P<0.05),lower PaO2([53.41±6.02)mmHg vs( 59.41±4.02)mmHg, P<0.05],higher PaCO2([50.73±5.91)mmHg vs( 40.73±5.91)mmHg, P<0.05],higher lactate value([3.97±3.76)mmol/L vs( 2.26±1.17)mmol/L, P<0.05]. Conclusion:The mortality rate of patients with acute severe left heart failure requiring invasive mechanical ventilation is high. The nonsurvival group has lower blood pressure, arterial blood pH value, lower PaO2 and higher PaCO2, lactate value, and the difference between the two group is statistically significant.

关 键 词：急性左心衰竭 有创机械通气 预后 死亡 

分 类 号：R542.22[医药卫生—心血管疾病]