无创正压通气对急性心肌梗死不良事件的预防作用  

Preventive effect of noninvasive positive-pressure ventilation on adverse events in patients with acute myocardial infarction

作　　者：王竟军[1] 郭晓洁[1] 戎雪冰[1] 赵琳[1] 刘洪波[1] 孙鲁华[1] 温省初[1] 

机构地区：[1]保定市第一医院ICU,河北保定071000

出　　处：《临床肺科杂志》2012年第2期244-245,共2页Journal of Clinical Pulmonary Medicine

摘　　要：目的观察无创正压通气(NPPV)在急性心肌梗死患者中不良事件的预防作用。方法 65例急性心肌梗死、Kil-lip分级I级的患者分为两组,NPPV组34例经口鼻面罩行NPPV,常规治疗组31例给予抗血小板、硝酸酯类、强心类和利尿剂药物以及实施静脉溶栓、急诊冠脉内支架植入等治疗措施。分析临床一般情况、心绞痛发作、恶性心律失常情况、心输出量(CO)、血管外肺水(EVLW)、死亡率,并进行Killip分级。结果经治疗24 h7、2 h、7天后,NPPV组心率、呼吸频率、动脉血氧分压、心输出血量和血管外肺水均有明显改善,分别与常规治疗组比较差异明显,有统计学意义(P<0.05);在治疗7天后,NPPV组发生心绞痛、恶性心律失常及死亡事件明显减少,与常规治疗组比较差异明显,有统计学意义(P<0.05);在治疗过程中,NPPV组心脏泵功能进展为KillipⅢ级、Ⅳ级的患者例数分别与常规治疗组比较差异明显,有统计学意义(P<0.05)。结论 NPPV是抢救急性心肌梗死患者的有效措施,对不良事件的发生有很好的预防作用。Objective To investigate the preventive effect of noninvasive positive - pressure ventilation （NPPV） on adverse events in patients with acute myocardial infarction. Methods A total of 65 patients with acute myocardial infarction, Killip classification I were separately divided into two groups, NPPV group （ n = 34 ） and routine treatment group （ n = 31 ）. The NPPV group treated with NPPV （ inspiratory pressure betweenl2 and 16 cm H20,expiratory pressure between 4 and 6 cm H20,Oxygen flow between 3 and 6 liter per minutes） more than 12 hours every day. The routine treatment group treated with drug therapy, intravenous thrombolysis and Emergency Coronary Stent Implantation. The general clinical situation, times of angina pectoris, malignant arrhythmia, cardiac output （CO） and extravascular lung water （EVLW） and mortality were compared between the two groups. Result After 24 hours,72hour and 7 day treatment,the heart rate, respiratory rate and EVLW of the NPPV group were lower than the routine treatment group, there were statistically significant between the two groups. But the arterial partial pressure of oxygen and CO of the NPPV group were higher than the routine treatment group, there were statistically significant between the two groups after treatment. In the treatment of 7 days, NPPV group angina pectoris, malignant arrhythmias and deaths were different, respectively, with routine treatment group, obviously, there statistically significant （P 〈 0. 05 ） ; in the course of treatment, NPPV group of cardiac pump function level progression Killip Ⅲ, Ⅳ class numbers of patients were 6 cases,5 cases, respectively, with routine treatment group （9 cases, 13 cases ） to compare the differences are significant, statistically significant （P 〈 0. 05 ）. Conclusion NPPV is a effective therapy for the patients with acute myocardial infarction. NPPV play a good prevention role in the adverse events of myocardial infarction.

关 键 词：无创正压通气 心肌梗塞 不良事件 预防 

分 类 号：R542.22[医药卫生—心血管疾病]