早期无创通气在抢救急性左心衰竭合并呼吸衰竭患者中的临床应用  

Clinical application of using noninvasive mechanical ventilation in acute left heart failure complicated with respiratory failure

作　　者：申前进[1] 阳文新[1] 吴飞[1] 江一帆[1] 尹述旺[1] 丁华[1] 申红[1] 

机构地区：[1]南京中医药大学附属八一医院急诊科,南京210002

出　　处：《东南国防医药》2017年第1期34-36,共3页Military Medical Journal of Southeast China

摘　　要：目的探讨急性左心衰竭合并呼吸衰竭早期应用无创机械通气的临床疗效。方法回顾性总结2012年5月至2016年2月期间我科收治的急性左心衰并呼吸衰竭患者64例,分为无创机械通气组(35例,常规药物治疗的基础上早期使用无创呼吸机辅助呼吸)和面罩吸氧组(29例,常规药物治疗的基础上使用面罩吸氧),对比分析两组患者治疗前后临床症状好转时间及呼吸频率(RR)、心率(HR)、血氧饱和度(SpO_2)、动脉血氧分压(PaO_2)、动脉血二氧化碳分压(PaCO_2)、C反应蛋白(CRP)、B型尿钠肽(BNP)的变化,同时对比分析两组患者治疗好转率、气管插管率和死亡率。结果无创机械通气组心功能改善时间明显短于面罩吸氧组,治疗好转率高于面罩吸氧组,无创机械通气组气管插管率和死亡率明显低于面罩吸氧组(P<0.05)。治疗后60例存活患者的心功能均有改善,与面罩吸氧组相比,无创机械通气组患者的RR、HR下降更显著,SpO_2、PaO_2升高更显著,PaCO_2、CRP、BNP下降更显著(P<0.05)。结论无创机械通气对治疗急性左心衰竭合并呼吸衰竭疗效确切,早期应用可及时纠正缺氧,提高治疗好转率,减少气管插管率及死亡率。Objective To analyze the clinical effects of early intervention and using the non-invasive ventilation in acute left heart failure complicated with respiratory failure. Methods Retrospective analysis was performed with the 64 cases with acute left heart failure complicated with respiratory failure admitted from May 2012 to February 2016. There were 35 cases in non-invasive ventilation group（ A group） and 29 cases in oxygen mask group（ B group）. The A group was given strong heart,diuretics,vasodilator and early ventilation. The B group was given strong heart,diuretics,vasodilator and mask oxygen treatment. After treatment,the SpO_2,PaO_2,PaCO_2,CRP,BNP,heart rate and respiratory rate were observed before and after treatment. The time of clinical improvement were compared. Results The clinical improvement time was shorter and intubation rate and mortality was significantly lower in mechanical ventilation than that of conventional treatment（ P〈0. 05）. After the treatment of early non-invasive ventilation in acute left heart failure complicated with respiratory failure,heart rate,respiratory rate,SpO_2,PaO_2,PaCO_2,CRP and BNP improved more obviously than that oxygen mask group,and the difference were statistically significant（ P〈0. 05）. Conclusion Using noninvasive ventilation treating acute left heart failure combined with respiratory failure in the early time can rapidly correct hypoxia,increase improvement rate,reduce intubation and mortality. So it is a fast,safe and effective rescue measure.

关 键 词：无创机械通气 急性左心衰 呼吸衰竭 

分 类 号：R541.6[医药卫生—心血管疾病]