双水平正压无创通气对重症心衰患者血流动力学的影响  

Effect of Bi-level positive pressure noninvasive ventilation on hemodynamics in patients with severe heart failure

作　　者：赵义祥 余小林[2] 程慧[2] 李国庆[2] ZHAO Yixiang;YU Xiaolin;CHENG Hui;LI Guoqing(Health Team of Karamay Detachment of the Chinese People’s Armed Police Force,Karamay Xinjiang 834000;The Department of Internia of Caidiology,The People’s Hospital of Xinjiang Uyghur Autonomous Region,Urumqi 830000,China)

机构地区：[1]武警新疆总队克拉玛依支队卫生队,新疆克拉玛依834000 [2]新疆维吾尔自治区人民医院心内科,乌鲁木齐830000

出　　处：《新疆医科大学学报》2021年第4期469-473,共5页Journal of Xinjiang Medical University

基　　金：新疆维吾尔自治区自然科学基金(青年基金)(2018D01C111)。

摘　　要：目的探讨双水平气道正压(BiPAP)无创通气对重症心衰患者血流动力学的影响。方法使用随机数字法将2017年9月-2019年9月就诊于新疆维吾尔自治区人民医院并使用脉搏指示连续心排血量监测系统(PiCCO)的60例重症心衰患者分为对照组和观察组,每组各30例,均给予心衰药物治疗,观察组在测得基线参数后给予BiPAP无创通气。两组患者在研究开始后0 h(T0,基线)及24h监测脑钠肽(BNP);在0 h(T0,基线)及1 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)校准PiCCO,获得PiCCO参数[心输出量指数(CI)、血管外肺水指数(EVLWI)]。对比两组患者血流动力学变化。结果给予BiPAP无创通气治疗前,两组患者BNP、CI、EVLWI差异均无统计学意义(P>0.05);给予BiPAP无创通气治疗24 h后,观察组较对照组BNP下降更显著(P<0.05);患者总体CI、EVLWI在接受治疗前后不同时间有统计学差异(P<0.05),CI随时间增加,EVLWI随时间下降;经治疗两组患者CI存在时间和通气方式之间的交互效应(P<0.05),治疗后8、24 h,组间差异有统计学意义,观察组CI改善更明显(P<0.05);两组EVLWI不存在时间和通气方式之间交互效应(P>0.05)。结论应用BiPAP无创通气有助于增加重症心衰患者心输出量,但对患者肺水肿程度的改善作用有限。Objective To investigate the effect of Bi-level positive airway pressure(BiPAP)non-invasive ventilator assisted ventilation on hemodynamics in patients with severe heart failure.Methods Using random number method,60 patients with severe heart failure who used pulse indicator continuous cardiac output monitoring system(PiCCO)from September 2017 to September 2019 in the People′s Hospital of Xinjiang Uyghur Autonomous Region were divided into control group and observation group,30 cases in each group.All patients were given heart failure medication,and the observation group was given BiPAP noninvasive ventilation after the baseline parameters were measured.Two groups of patients monitored brain natriuretic peptide(BNP)at 0 h(T0,baseline)and 24 h after the start of the study;Pi CCOwas calibrateatd at 0 h(T0,baseline)and 1 h(T1),4 h(T2),8 h(T3),24 h(T4)and obtained Pi CCO parameters[cardi-ac output index(CI),extravascular lung water index EVLWI].The hemodynamic changes were compared between thetwo groups.Results There was no significant difference in BNP,CI and EVLWI between the two groups before thetreatment.After treatment,the observation group had a more significant decrease in BNP than those in the controlgroup(P<0.05).The total CI and EVLWI of the patients were different at different times before and after treatment,and the difference was statistically significant(P<0.05),CI increased with time,while EVLWI decreased with time.After treatment,the CI of the two groups of patients had an interactive effect between time and ventilation mode(P<0.05).The difference between the groups at 8 and 24 hours after treatment was statistically significant,and the im-provement of CI was more obvious in the observation group(P<0.05).There was no interaction between time and ven-tilation mode in EVLWL of the two groups(P>0.05).Conclusion The application of Bi PAP non-invasive ventilationcan help increase the cardiac output of patients with severe heart failure,but it has limited effect on reducing the de-gree of pulmonary edema

关 键 词：心力衰竭 双水平气道正压无创通气 脉搏指示连续心排血量监测 血流动力学 

分 类 号：R541.6[医药卫生—心血管疾病]