无创正压机械通气对急性左心衰竭患者左室结构的影响  

The effects of noninvasive positive pressure ventilation on left heart structure of the patients with acute left heart failure

作　　者：谭利国[1] 肖俊会[1] 王家宁[1] 车军[2] 余丹丽[2] 

机构地区：[1]湖北医药学院附属人民医院心脏中心,湖北十堰442000 [2]湖北医药学院附属人民医院急诊科,湖北十堰442000

出　　处：《中西医结合心血管病电子杂志》2016年第11期1-3,共3页Cardiovascular Disease Electronic Journal of Integrated Traditional Chinese and Western Medicine

摘　　要：目的 本研究旨在观察无创正压机械通气（noninvasive positive pressure ventilation NIPPV）对急性左心衰竭患者左室结构的影响。方法 选取2015年1月~2015年11月十堰市人民医院急诊科收治的急性左心衰竭患者105例作为研究对象,将其随机分为NIPPV组55例和对照组50例。比较两组治疗后心脏左室舒张末内径（Left Ventricular End Diastolic Dimension,LVEDD）、左室收缩末期内径（Left Ventricular End Systolic Diameter,LVESD）、左室舒张末期容积（Left Ventricular End Diastolic Volume,LVEDV）、左室收缩末期容积（Left Ventricular End Systolic Volume,LVESV）、左室射血分数（Left Ventricular Ejection Fraction,LVEF）、血清N末端B型脑钠肽前体（N-terminal pro-Brain Natriuretic Peptide,NT-pro BNP）指标的变化。结果 两组患者治疗前NT-pro BNP、收缩压（Systolic Blood Pressure,SBP）、舒张压（Diastolic Blood Pressure,DBP）、心率（Heart Rate,HR）、呼吸频率（Respiratory Rate,RR）、PH（Potential of Hydrogen,PH）、PCO2（Arterial Carbon Dioxide Tension）、PO2（Arterial Oxygen Tension）比较,差异无统计学意义（P〉0.05）,治疗后两组在SBP、DBP指标比较,差异无统计学意义（P〉0.05）,在NT-pro BNP、HR、RR、PCO2、PO2、PH值指标上,NIPPV组较对照组有更显著地改善,差异有统计学意义（P〈0.05）;同时NIPVV组较对照组更显著地改善左室结构（LVEDD、LVESD、LVEDV、LVESV）及功能指标（LVEF）,差异有统计学意义（P〈0.05）。结论 无创正压机械通气在急性左心衰竭患者的使用不仅能迅速有效纠正患者的低氧血症、高碳酸血症对心脏的毒性作用,而且减少肺静脉血回流,降低左心室前负荷,减轻心脏负担,从而改善左室重构和心脏功能。Objective To observe the effects of noninvasive positive pressure ventilation（NIPPV） on left heart structure of the patients with acute left heart failure.Methods 105 patients with acute left heart failure admitted to our emergency department from January,2015 to November 2015 were included,and divided into two groups randomly,included NIPPV group and control group.LVEDD,LVESD,LVEDV,LVESV,LVEF and levels of NT-proBNP of two groups were measured before and at 24 hours after treatment.Results NT-proBNP,SBP,DBP,HR,RR,PH,PCO2,and PO2 of two groups before treatment had no statistical difference. However,compared with control group after treatment,NIPPV group were more obviously ameliorated at index of HR,RR,PCO2,PO2,the value of PH and the level of NT-proBNP（P〈0.05）,more significantly improved LVEF and decreased LVEDD,LVESD,LVEDV and LVESV （P〉0.05）,but have no statistical difference on SBP and DBP（P〉0.05）.Conclusion NIPPV not only effectively improved hypoxemia,reduced PCO2,but also increased cardiac function,reversed left ventricular remodeling of patients with acute left heart failure.

关 键 词：无创正压机械通气 急性左心衰竭 左室重构 

分 类 号：R541.6[医药卫生—心血管疾病] R563.8[医药卫生—内科学]