无创面罩双水平气道正压通气治疗急性左心衰竭  

Clinical research of Non-invasive bi-level positive airway pressure mask ventilation for acute left heart failure

作　　者：谢宜[1] 陈雪枝[1] 林锐波[1] 陈雪华[1] 

机构地区：[1]广东省潮州市中心医院急诊科,广东潮州521000

出　　处：《中国现代医生》2012年第9期60-62,共3页China Modern Doctor

摘　　要：目的探讨无创面罩双水平气道正压通气(BiPAP)治疗急性左心衰竭的疗效。方法随机将52例急性左心衰竭患者分为治疗组和对照组各26例。两组均采用常规药物治疗,治疗组加用BiPAP治疗。观察两组患者治疗前及治疗2 h后的临床表现、动脉血气分析情况;比较治疗组通气前与通气后2 h、12 h血清B型钠尿肽(BNP)以及左室射血分数(LVEF)的变化。结果治疗组总有效率92.30%,对照组总有效率53.85%,两组比较差异有统计学意义(χ2=7.917,P<0.005);治疗组通气2 h后心功能、平均动脉血压(MBP)、心率(HR)、呼吸频率(RR),pH、PaO2、PaCO2、SaO2指标明显改善,与对照组比较差异有统计学意义(t=9.193、13.683、22.795、9.333、10.232、3.882、7.956,P<0.001);治疗组通气2 h、12 h后BNP指标明显降低,LVEF明显增加,与通气前比较差异有统计学意义(t=7.991、9.427,P<0.001;t=2.609、4.851,P<0.05、P<0.001)。结论 BiPAP治疗急性左心衰竭能迅速改善患者心肺功能,是提高抢救成功率的一种有效方法。Objective To discuss the curative effect of Non-invasive bi-level positive airway pressure mask ventilation （Bi- PAP） for acute left heart failure. Methods Fifty-two cases of acute left heart failure were randomly divided into treatment and control groups for average. Two groups were treated with conventional drug. And the treatment group were treated with BiPAP based on the drug therapy. The clinical manifestations and arterial blood gas analysis of these two groups before ventilating and after 2 h were observed. The changes of serum B-type natriuretic peptide （BNP） and left ventricular ejection fraction （LVEF） of the treatment group before ventilating and after 2 h and 12 h treatment were compared. Results The to- tal efficiency of treatment group was 92.30%, and the control group was 53.85%. The difference of statistics of these two groups was significant （X2=7.917 ,P 〈 0.005）. Compared with the control group, the cardiac function, indicators of the mean arterial blood pressure （MBP）, heart rate （HR）, respiratory rate （RR） and the pH, PaO2, PaCO2 and SaO2 of the treatment group were significantly improved after 2 h of ventilating （t = 9.193, 13.683, 22.795, 9.333, 10.232, 3.882, 7.956, P〈 0.001）. The indicators of BNP was significantly reducing after ventilating 2 h and 12 h, and the LVEF was significantly in- creasing after ventilating 2 h and 12 h. Compared with the BNP and LVEF before ventilating, the indicators of that after 2 h and 12 h ventilating had statistical significance （t = 7.991, 9.427, P 〈 0.001; t = 2.609, 4.851, P 〈 0.05, P 〈 0.001）. Conclusion Patients with acute left heart failure who were treated with the BiPAP can rapidly improve cardiopulmonary function. So the BiPAP is an effective assisted therapy which can improve the success rate of rescuing.

关 键 词：急性左心衰竭 无创性面罩双水平气道正压通气(BiPAP) 动脉血气分析 血清B型钠尿肽(BNP) 左室射血分数(LVEF) 

分 类 号：R541.6[医药卫生—心血管疾病]