吗啡联合无创正压机械通气治疗急性左心衰竭的疗效观察  

Effect of morphine combined with noninvasive positive pressure ventilation in the treatment of patients with acute left heart failure

作　　者：吴晓玉[1] 周勇[1] 林鹏 尹聪聪 Wu Xiaoyu, Zhou Yong,Lin Peng, Yin Congcong.(Department of Emergency, the First People＇s Hospital of Taizhou , Taizhou , Zhejiang 318300, China)

机构地区：[1]台州市第一人民医院急诊科,浙江省台州318300

出　　处：《中国基层医药》2018年第6期728-732,共5页Chinese Journal of Primary Medicine and Pharmacy

摘　　要：目的探讨吗啡联合无创正压机械通气治疗急性左心衰竭的疗效。方法收集急性左心衰竭患者80例，采用随机数字表法分为两组，每组40例。对照组给予无创正压机械通气治疗，观察组加用吗啡镇静，比较两组生命体征检测指标、疾病相关参数、临床事件、认知功能与生活质量。结果观察组治疗后30min收缩压、心率、呼吸频率、血二氧化碳分压（PaCO2）均显著低于对照组，血氧分压（PaO2）与酸碱度（pH）值均显著高于对照组；治疗后24h动脉氧分压（SaO2）、尿量均显著高于对照组，急性生理与慢性健康评分（APACHE1I）、脑尿钠肽（BNP）、高敏肌钙蛋白（hs—cTnl）、肌酸激酶（CK）水平均显著低于对照组，差异均有统计学意义（t=8．349、13．127、7．413、17．072、15．334、2．631、3．088、12．371、8．061、4．784、18．931、6．568、9．464，均P〈0．01）；观察组气管插管率显著低于对照组（0．0％比20．0％），48h内撤机率显著高于对照组（85．0％比50．0％），差异均有统计学意义（Х^2=6．806、11．168，均P〈0．01）；观察组治疗后3个月明尼苏达心力衰竭生活质量问卷（MLHFQ）总分显著低于对照组[（24．69±5．38）分比（38．24±8．03）分]，差异有统计学意义（t=8．866，P〈0．01）；两组治疗后蒙特利尔认知评估量表（MoCA）总分差异无统计学意义[（24．80±2．93）分比（25．07±2．33）分，t=．456，P〉0．05]。结论吗啡联合无创正压机械通气治疗急性左心衰竭疗效显著，具有借鉴意义。Objective To investigate the effect of morphine combined with noninvasive positive pressure ventilation in the treatment of patients with acute left heart failure. Methods 80 patients with acute left heart failure were enrolled,and they were randomly divided into two groups according to the digital table method,40 cases in each group. The patients in the control group were treated with noninvasive positive pressure mechanical ventilation. The patients in the observation group were treated with morphine sedation on the basis of the treatment of the control gorup. The vital signs test indicators, disease-related parameters, clinical events, cognitive function and quality of life were compared between the the two groups. Results The systolic blood pressure, heart rate, respiratory rate, PaCO2 and myocardial oxygen consumption in the observation group were significantly lower than those in the control group at 30min after treatment, PaO2 and pH in the observation group were significantly higher than those in the control group, the APACHE Ⅱ , BNP, Hs-cTnl and CK levels in the observation group at 24 h after treatment were significantly lower than those in the control group, the differences were statistically significant （t = 8. 349,13. 127,7.413,17. 072, 15. 334,2. 631,3. 088,12. 371,8. 061,4.784,18. 931,6. 568,9. 464, all P 〈 0.01 ）. The rate of tracheal intubation of the observation group was significantly lower than that of the control group（0.0% vs. 20.0% ） ,the rate of withdrawal of the observation group was significantly higher than tbat of the control group （ 85.0% vs. 50. 0% ） , the differences were statistically significant （ Х^2 = 6. 806,11. 168, all P 〈 0. 01 ）. The MLHFQ score of the observation group 3 months after treatment was significantly lower than that in the control group [ （ 24. 69 ± 5.38） points vs. （ 38. 24 ± 8.03 ） points ] , the difference was statistically significant （ t = 8. 866, P 〈 0.01 ）. There was no statistically significant difference in MoCA sco

关 键 词：心力衰竭 通气机 机械 正压呼吸 吗啡 生活质量 

分 类 号：R541.6[医药卫生—心血管疾病]