无创正压通气治疗老年急性左心衰竭合并肺水肿的临床研究  

Clinical study of noninvasive positive pressure ventilation in the therapy of older patients with acute left heart failure and pulmonary edema

作　　者：卓安山[1] 李奕[1] 官振标[1] 徐世林[1] 童皖宁[1] 李雷[1] 赵红霞[1] 

机构地区：[1]上海解放军第411医院呼吸科,200081

出　　处：《中华肺部疾病杂志（电子版）》2015年第5期46-50,共5页Chinese Journal of Lung Diseases(Electronic Edition)

基　　金：上海市虹口区卫计委基金资助课题(虹卫1302-13)

摘　　要：目的探讨无创正压通气(NPPV)治疗老年急性左心衰竭合并肺水肿的疗效及安全性。方法选择79例符合一定条件的急性左心衰竭患者随机分成两组,两组均采用常规综合治疗包括强心、利尿和应用血管活性药物等;对照组39例,加用鼻导管或高氧面罩吸氧,观察组40例,加用NPPV治疗。观察两组治疗前及治疗后30 min、2 h、4 h临床疗效及呼吸频率(HR)、心率(HR)、动脉血氧分压(Pa O2)、指脉氧饱和度(Sp O2)及血浆B型钠尿肽(BNP)水平和左室射血分数(LVEF)的变化。结果观察组显效率(70.0%)和总有效率(92.5%)均明显高于对照组(分别为43.6%和74.4%),两组比较,差异有明显的统计学意义(P<0.05);观察组治疗后30 min、4 h测得的RR、HR、Pa O2、Sp O2等指标均明显优于对照组,两组比较,差异分别有明显的统计学意义(P<0.05);观察组治疗后4 h血浆BNP水平(712.8±112.5)pg/ml和LVEF(53.6%±8.1%)改善情况明显优于对照组,分别为(986.4±145.7)pg/ml和(46.7%±9.5%),两组比较,差异分别有明显的统计学意义(P<0.05)。结论 NPPV不仅能改善老年急性左心衰竭患者的氧合和通气功能,纠正其呼吸衰竭,并可改善其心功能,加速心功能恢复,纠正心力衰竭。Objective To assess the efficacy and safety of noninvasive positive pressure ventilation（ NPPV） in the therapy of older patients with acute left heart failure（ ALHF） and pulmonary edema. Methods Seventy nine patients with ALHF and pulmonary edema were randomizedly divided into the control group and the therapy group. 40 cases of the therapy group were treated by NPPV on the basis of routine therapy,39 cases of the control group were given by on the basis of routine therapy. The symptoms,signs,respiratory rate（ RR）,heart rate（ HR）,Pa O2,Sp O2,plasma B-type natriuretic peptide（ BNP） concentration,Left ventricular ejection fraction（ LVEF） of the two groups were detected respectively before and at 30 min,2 h,4 h after therapy. The efficacy and safety were compared between the two groups. Results The efficacy rate and overall response rate（ 70. 0%,92. 5%） in the therapy group was higher than those in the control group（ 43. 6%,74. 4%）,there were significant differece between two group（ P 〈 0. 05）. HR,RR,Pa O2 and Sp O2 in the therapy group were more significantly improved than those of the control group at 30 min,4 h after therapy,there were significant differece between two group（ P 〈 0. 05）. Plasma BNP（ 712. 8 ± 112. 5） g / ml and LVEF（ 53. 6% ± 8. 1%） in the therapy group were markedly improved than those of the control group（ 986. 4 ±145. 7） pg / ml,（ 46. 7% ± 9. 5%） at 4 h after therapy（ P 〈 0. 05）. Conclusions These results suggested that NPPV can regulate HR. RR,Pa O2 and Sp O2 value to acceptable levels. It is proved to be an effective and safe method for the treatment of patients with ALHF with pulmonary edema.

关 键 词：无创正压通气 急性左心衰竭 肺水肿 B型钠尿肽 左室射血分数 

分 类 号：R541.6[医药卫生—心血管疾病]