机械通气治疗重症急性左心力衰竭的临床疗效分析  

Clinical study on mechanical ventilation for acute left ventricular failure.

作　　者：徐云海[1] 蒋兆华[1] 

机构地区：[1]上海市浦东新区浦南医院急诊ICU,200125

出　　处：《中国综合临床》2009年第8期812-814,共3页Clinical Medicine of China

摘　　要：目的探讨机械通气治疗重症急性左心力衰竭的临床疗效。方法74例重症急性左心力衰竭患者，26例给予鼻导管吸氧或面罩吸氧及正性肌力药物、利尿剂、扩血管药物、镇静药物等常规治疗，48例根据临床情况辅以机械通气治疗，观察2组患者治疗前后生命体征、血气分析、血流动力学的改变。结果常规治疗组26例患者中死亡18例（70．9％），机械通气组48例患者经机械通气治疗后，死亡5例（10．4％），组间病死率比较差异有统计学意义（Х^2=23．5，P〈0．05）。26例患者常规治疗2h与治疗前比较，HR、MAP、CVP、pH、PCO2、PO2、HCO3^-和SO2均显著改善（t值分别为3．71，2．34，2．74，6．02，3．08，5．11，9．81，12．13，P〈0．05或〈0．01），48例患者机械通气2h后与治疗前比较，上述指标亦显著改善（t值分别为11．76、0．48、1．12、6．99、9．41、20．79、10．01、12．38，P〈0．05或0．01），机械通气2h与常规治疗2h比较，HR、CVP、pH、PCO2、PO2、HCO3^-、SO2改善明显（P〈0．05或0．01）。结论适时地气管插管行机械通气能有效改善重症急性左心力衰竭所致的低氧血症和高碳酸血症，短时间内纠正严重低氧状态，是成功抢救重症急性左心力衰竭的关键措施。Objective To research the clinical value of mechanical ventilation in the treatment of acute left ventricular failure. Methods Of 74 case with acute left ventricular failure,26 cases recevived routine treatment including nasal-catheter inhale of oxygen or veil inhale of oxygen and inotropic agent, diuretic, and dilation as well as sedative while the mechanical ventilation group were treated only with mechanical ventilation depending on the condition. The clinical indications, parameters of blood gas analysis and hemodynamics were compared before and after treatment. Results 18 cases from routine treatment group died（70.9% ） and 5 died in mechanical ventilation group （10.4%）. There was significant difference in heart rates （HR） ,central venous pressure （CVP） ,the mean arterial blood pressure （MAP） and some parameters of blood gas analysis before and after the treatment （P 〈 0.05 or P 〈 0.01 ）, after treatments, HR, CVP, pH, PCO2, PO2, HCO3^ - , SO2 were more improved in mechanical ventilation group than in routine treatment group （ P 〈 0.05 or P 〈 0.01 ）. Conclusions Prompt endotracheal intubation for mechanical ventilation is an effective procedure in correcting hypoxemia and hypercarbia induced by acute left ventricular failure. It can correct severe hypoxemic conditions in a short time and may serve as the key procedure in successfully rescuing patients with acute left vertricular failure.

关 键 词：急性左心力衰竭 机械通气 

分 类 号：R541.6[医药卫生—心血管疾病] R563.8[医药卫生—内科学]