无创呼吸机治疗对尿毒症并急性左心衰患者的临床疗效分析  

Efficiency of continuous positive airway pressure treatment in uremia patients with acute left heart failure

作　　者：吴明[1] 杨秀林[1] 周永刚[1] 廖剑雄[1] 

机构地区：[1]贵州省人民医院急诊科,贵阳550002

出　　处：《第三军医大学学报》2016年第21期2353-2356,共4页Journal of Third Military Medical University

基　　金：贵州省科技厅项目[黔科合J字[2010]2169号;黔科合LH字[2014]7026号]~~

摘　　要：目的观察同时使用无创呼吸机辅助通气治疗对尿毒症并急性左心衰患者的疗效。方法对贵州省人民医院急诊内科门诊2013年11月至2016年3月63例确诊尿毒症并急性左心衰患者进行观察。将患者分为对照组[n=31,年龄（46.2±13.2）岁]及治疗组[n=32,年龄（47.2±14.8）岁]。对照组只进行常规吸氧、强心、利尿、扩血管治疗,治疗组在常规治疗同时进行无创呼吸机治疗。记录治疗前、治疗2 h末患者临床症状及心率（HR）、呼吸频率（RR）、收缩压（SBP）、舒张压（DBP）、动脉血氧分压（Pa O2）指标变化,2 h末血浆脑钠肽（BNP）、血乳酸（Lac）水平变化。结果治疗2 h末,与对照组比较,治疗组HR[（96.7±9.1）/min vs（106.6±10.3）/min]、RR[（21.0±1.6）/min vs（23.8±1.8）/min]、SBP[（140.1±9.2）mm Hg vs（148.5±19.0）mm Hg]、DBP[（86.2±6.4）mm Hg vs（98.8±10.2）mm Hg]、Pa O2[（96.6±5.7）mm Hg vs（87.2±7.7）mm Hg]、BNP[（1 721.0±794.6）ng/L vs（2 226.4±760.1）ng/L]、Lac[（3.50±1.27）mmol/L vs（4.74±1.42）mmol/L]均有改善（P〈0.05）。治疗组急诊透析率明显低于对照组（χ-2=14.385,P〈0.01）。治疗组治疗有效率高于对照组（χ-2=15.432,P〈0.01）。结论同时使用无创呼吸机辅助治疗能安全、有效地缓解尿毒症并急性左心衰患者临床症状及改善心功能。Objective To investigate the clinical efficiency of noninvasive ventilation therapy with continuous positive airway pressure on the uremia patients with acute left heart failure.Methods Sixty-three uremia patients complicated with acute left heart failure admitted in our emergency department from November2013 to March 2016 were recruited into this study.The patients were randomly divided into control group（ n = 31,at a mean age of 46.2 ± 13.2） and treatment group（ n = 32,at a mean age of 47.2 ± 14.8）.The patients from the both groups were treated by oxygen inhalation,cardiotonic agents,diuretic drugs,vasodilator treatment and other conventional drug treatment,and those of the treatment group were given the treatment of continuous positive airway pressure at the same time.The clinical manifestations, heart rate（ HR）,respiratory rate（ RR）,systolic blood pressure（ SBP）,diastolic blood pressure（ DBP） and arterial partial pressure of oxygen（PaO2） were measured and recorded in the beginning and after 2 hours＇ treatment.The levels of blood brain natriuretic peptide（ BNP） and lactate（ Lac） were detected too.Results After2 hours＇ treatment,the parameters in the treatment group were markedly improved when compared with the control group（ HR： 96.7 ± 9.1 vs 106.6 ± 10.3 beats/min,RR： 21.0 ± 1.6 vs 23.8 ± 1.8 times/min,SBP：140.1 ± 9.2 vs 148.5 ± 19.0 mm Hg,DBP： 86.2 ± 6.4 vs 98.8 ± 10.2 mm Hg,Pa O2： 96.6 ± 5.7 vs 87.2 ±7.7 mm Hg,BNP： 1 721.0 ± 794.6 vs 2 226.4 ± 760.1 ng/L,Lac： 3.50 ± 1.27 vs 4.74 ± 1.42 mmol/L,all P〈0.05）.The proportion of emergent hemodialysis was significant lower（ Chi square = 14.385,P〈0.01）,and clinical response was obviously higher（ Chi square = 15.432,P〈0.01） after 2 hours＇ treatment in the treatment group than the control group.Conclusion Simultaneous noninvasive ventilation therapy with continuous positive airway pressure is safer and more effective for clinical manifestations and cardiac functions in the uremia

关 键 词：尿毒症 急性左心衰 无创通气 疗效 

分 类 号：R197.39[医药卫生—卫生事业管理] R541.605[医药卫生—公共卫生与预防医学]