机械通气在产科心力衰竭患者围手术期的应用价值  

Application value of mechanical ventilation at perioperation of obstetric patients with heart failure

作　　者：郭伟平[1] 申沛[1] 林耀蕙[1] 朱芳芳[1] 王军[1] 刘勇战 李卫[1] GUO Wei-ping SHEN Pei LIN Yao-hui et al(Center of Obstetrics and Gynecology,the No.152 Central Hospital of PLA, Pingdingshan, Henan 467000, China)

机构地区：[1]解放军152医院妇产科,河南平顶山467000

出　　处：《实用医药杂志》2017年第3期210-212,共3页Practical Journal of Medicine & Pharmacy

摘　　要：目的探讨机械通气在产科心力衰竭患者围手术期中的应用价值。方法对2009年1月—2014年1月笔者所在医院产科围手术期危重症患者64例的资料进行回顾性分析。患者因不同病因导致心力衰竭、肺水肿或多脏器功能衰竭,均同时对原发病进行治疗。其中42例患者在常规强心、利尿等治疗的同时进行机械通气作为研究组,其余22例患者常规强心、利尿等治疗,不使用机械通气作为对照组。对两组患者临床症状体征如呼吸困难、发绀、泡沫痰、肺部湿罗音及生命体征、血气分析、动脉血氧饱和度(SaO_2)、血浆脑钠肽(BNP)等指标进行监测。结果(1)研究组42例患者使用机械通气2 h后临床症状及呼吸、心率等生命体征较对照组明显好转,其差异有统计学意义(P<0.05)。(2)研究组使用机械通气2 h后,动脉血气指标明显改善,差异有统计学意义(P<0.05);此外,与对照组相比,研究组机械通气2 h后动脉血气指标改善程度较高,差异有统计学意义(P<0.05)。(3)治疗2 h后研究组血浆BNP水平显著低于对照组,差异有统计学意义(P<0.05)。结论产科危重症患者因妊娠特殊的血流动力学改变,围手术期极易出现心力衰竭、肺水肿或多脏器功能衰竭危及生命,单纯药物治疗效果不佳。当患者临床出现呼吸困难、发绀和(或)泡沫痰、心电监护提示SaO_2较低时,在治疗基础疾病、纠正心力衰竭的同时,及时应用机械通气,能迅速纠正患者低氧血症、改善心肺功能,为患者提供基本的生命支持。Objective To study application value of mechanical ventilation in perioperative obstetric patients with heart failure. Methods The data of 64 critically perioperative obstetric patients,who required mechanical ventilation in author＇s hospital from January 2009 to January 2014,were analyzed retrospectively. The 64 patients with heart failure,pulmonary edema caused by different causes or multiple organ function failure,all at the same time were subject to cure the primary disease. Among them 42 patients were grouped as the study group received conventional strong heart,diuresis,at the same time associated with mechanical ventilation. The rest 22 cases as control group received conventional treatment such as strong heart,diuresis,but without the use of mechanical ventilation. The data were analyzed in two groups including Clinical symptoms and signs such as difficulty in breathing,purple purple,wet PaoMoTan,lung rule and vital signs,blood gas analysis,blood oxygen saturation（SaO2） ,plasma brain urine sodium peptide（BNP） and so on. Results 1 ）In the study group ,the clinical symptoms and breathing,heart rate and other vital signs were improved obviously after mechanical ventilation for 2 hours,the difference was statistically significant （P〈0.05）. 2）In the study group after mechanical ventilation for 2 hours,arterial blood gas index got improved significantly,the difference was statistically significant （P〈0.05） ;In addition,compared with the control group,the degree of arterial blood gas index got improved after mechanical ventilation for 2 hours in the study group （P〈0.05）. 3）The plasma BNP level after mechanical ventilation for 2 hours in the study group was significantly lower than in the control group （P〈0.05）. Conclusion Critical-ill obstetric patients appeared easily with heart failure,pulmonary edema,or multiple organ failure perioperatively because of their special pregnancy hemodynamie changes,however,the treatment of the pure medication was bad. When the onset of dys

关 键 词：机械通气 心力衰竭 产科 围手术期 

分 类 号：R714.252[医药卫生—妇产科学]