小剂量吗啡在急性左心衰竭急诊急救中的应用效果观察  

Application Effect of Small-dose Morphine in Emergency Treatment of Acute Left Ventricular Failure

作　　者：于金珍 张玉岭 田春丽 韩克领 杨至佳 

机构地区：[1]河北省黄骅市神农居医院,061109 [2]黄骅市人民医院 [3]黄骅市妇幼保健院

出　　处：《实用心脑肺血管病杂志》2015年第12期99-101,共3页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

摘　　要：目的观察小剂量吗啡在急性左心衰竭急诊急救中的应用效果。方法选取2014年1月—2015年1月黄骅市神农居医院收治的急性左心衰竭患者60例,根据吗啡使用剂量分为和对照组和观察组,每组30例。两组患者入院后均给予常规治疗,对照组患者在常规治疗基础上给予大剂量吗啡（2.5-5.0 mg）,观察组患者在常规治疗基础上给予小剂量吗啡（1.0-2.0 mg）。比较两组患者治疗前及治疗后12 h生命体征〔收缩压（SBP）、舒张压（DBP）、心率（HR）、动脉血氧饱和度（SaO2）及动脉血氧分压（Pa O2）〕、治疗前及治疗后3 d心功能指标〔舒张早期充盈峰速度（E峰）、舒张晚期充盈峰速度（A峰）、E/A比值、左心室射血分数（LVEF）及左心室舒张末期内径（LVEDD）〕及神经体液指标〔血清脑钠肽（BNP）、内皮素（ET）及心肌肌钙蛋白T（cTnT）水平〕。结果两组患者治疗前SBP、DBP、HR、SaO2、PaO2、E峰、A峰、E/A比值、LVEF、LVEDD及血清BNP、ET、cTnT水平比较,差异均无统计学意义（P〉0.05）;观察组患者治疗后SBP、DBP、HR及血清BNP、ET、cTn T水平低于对照组,Sa O2、Pa O2、E峰、A峰、E/A比值、LVEF高于对照组,LVEDD大于对照组（P〈0.05）。结论小剂量吗啡有助于降低急性左心衰竭患者血压、减慢心率、改善气体交换功能及心脏舒缩功能、调节神经体液平衡,用于抢救急性左心衰竭效果良好。Objective To observe the application effect of small - dose morphine：in emergency treatment of acute left ventricular failure. Methods A total of 60 patients with acute left ventricular failure were： selected in Shennongju Hospital of Huanghua from January 2014 to January 2015, and they were divided into control group and observation group according to the dose of morphine, each of 30 cases. Patients of both groups received conventional treatment after admission, and patients of control group received extra large- dose morphine （2. 5 -5.0 mg） , while patients of observation group received extra small - dose morphine （ 1.0 -2.0 mg）. Vital signs （including SBP, DBP, HR, SaO2 and PaO2） before treatment and after 12 hours of treatment, cardiac function index （including E value, A value, E/A ratio and LVEF ） and neurohumoral indicators （including serum levels of BNP, ET and cTnT） before treatment and after 3 days of treatment were compared between the two groups. Results No statistically significant differences of SBP, DBP, HR, SaO2, PaOz, E value, A value, E/A ratio, LVEF, LVEDD, serum level of BNP, ET or cTnT was found between the two groups before treatment （ P 〉 0. 05 ） ; after treatment, SBP, DBP, HR, serum levels of BNP, ET and eTnT of observation group were statistically significantly lower than those of control group, while SaO2 , PaO2, E value, A value, E/A ratio, LVEF of observation group were statistically significantly higher than those of control group, LVEDD of observation group was statistically significantly bigger than that of control group （ P 〈 0. 05 ）. Condusion Small - dose morphine has good application effect in the emergency treatment of acute left ventrieular failure, is helpful to reduce the blood pressure and HR, improve the gas exchange function and cardiac systolic and diastolic function, maintain a balance of neurohumoral indicators.

关 键 词：心力衰竭 吗啡 急诊处理 心脏功能试验 

分 类 号：R541.6[医药卫生—心血管疾病]