早期有创机械通气治疗急性左心衰竭时机选择的临床研究  

Timing of Invasive Mechanical Ventilation in Patients with Acute Left Heart Failure

作　　者：曹海泉 何晓山[1,2] 王晓娟 臧泽林[1,2] 张应宏 雷霆[1,2] 

机构地区：[1]南充市中心医院 [2]川北医学院第二临床学院重症医学科,637000

出　　处：《天津医药》2013年第11期1079-1081,共3页Tianjin Medical Journal

摘　　要：目的 探讨急性左心衰竭治疗中有创机械通气的应用时机。方法32例急性左心衰患者中17例在发病起始时采用无创机械通气（无创组），15例在起始时采用气管插管有创机械通气（有创组）。观察比较2组患者机械通气后0.5、1、3 h症状缓解人数、住院病死率、呼吸频率（RR）、动脉血氧分压[p（O2）]、心率（HR）、平均动脉压（MAP）。结果 无创组10例患者在0.5 h内缓解，7例未缓解者改行气管插管机械通气，其中3例在0.5~1 h缓解，4例死亡；有创组14例在0.5 h内缓解，1例在0.5-1 h缓解，无死亡。有创组0.5 h内缓解人数多于对照组（P=0.041）；2组0.5-1 h缓解人数（P=1.000）和病死率（P=0.104）差异均无统计学意义。2组RR、HR均随治疗时间增加而降低，p（O2）、MAP均随时间增加而增加；0.5、1 h时有创组RR低于无创组，0.5 h时有创组p（O2）、MAP高于无创组，0.5、3 h时有创组HR低于无创组（均P＜0.05）。结论 应用无创机械通气治疗0.5 h症状不缓解时应尽早改用有创机械通气。Objective To investigate the various occasions of invasive mechanical ventilation in patients with acute left heart failure. Methods Thirty-two patients with acute severe left heart failure were divided into two groups： 17 patients were treated with non-invasive mechanical ventilation （non-invasive mechanical ventilation group） and 15 patients were treated with invasive mechanical ventilation （invasive mechanical ventilation group）. The respiratory rate （RR）, arterial oxy- gen partial pressure p（O2）, heart rate （HR） and mean arterial pressure （MAP） were observed after treatment for 0.5 h,1 h and 3 h in two groups of patients. The in-hospital mortality was compared between two groups. Results Ten patients of non-in- vasive mechanical ventilation group were in remission after 0.5 h, 7 cases without remission switched to endotracheal intuba- tion for invasive mechanical. And 3 of them were in remission in 0.5~1 h, 4 of them dead. Fourteen patients in invasive me- chanical ventilation group were in remission after 0.5 h, one case was in remission after 0.SN1 h and no dead in this group. There were more patients in remission after 0.5 b in invasive mechanical ventilation group than those of non-invasive me- chanical ventilation group （P=0.041）. There were no significant differences in the number of patients in clinical remission af- ter 0.SN1 h and mortality between two groups. The values of RR and HR were decreased with the increasing treatment time in two groups. The values ofp（O2） and MAP were increased with the increasing treatment time in two groups. There was a sig- nificantly lower RR at 0.5 h and 1 h in invasive mechanical ventilation group than that of non-invasive mechanical ventila- tion group （P 〈 0.05）. The values of p（O2） and MAP were significantly higher at 0.5 h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group （P 〈 0.05）. The levels of HR at 0.5 h and 3 h were significant- ly lower in invasive mechanical v

关 键 词：心力衰竭 插管法  气管内 有创机械通气 无创机械通气 急性左心衰竭 时机 

分 类 号：R563.8[医药卫生—呼吸系统]