无创呼吸机辅助通气序贯高流量吸氧治疗重症急性左心衰竭合并呼吸衰竭疗效观察  

Efficacy of non-invasive ventilator-assisted ventilation sequential high-flow oxygen inhalation in the treatment of patients with severe acute left ventricular failure complicated with respiratory failure

作　　者：余征 王建文 马腾 Yu Zheng;Wang Jianwen;Ma Teng(Pingmei Shenma Medical Group General Hospital,Pingdingshan 467000,Henan,China)

机构地区：[1]平煤神马医疗集团总医院,河南平顶山467000

出　　处：《临床心身疾病杂志》2022年第2期114-117,共4页Journal of Clinical Psychosomatic Diseases

基　　金：平顶山市科技攻关计划项目(编号2017330154)。

摘　　要：目的探讨无创呼吸机辅助通气序贯高流量吸氧治疗重症急性左心衰竭合并呼吸衰竭患者的疗效。方法将82例重症急性左心衰竭合并呼吸衰竭患者按随机数字表法分为观察组(42例)和对照组(40例)。两组均给予引流、祛痰、抗凝、营养支持及雾化吸入等常规治疗,对照组在此基础上给予无创正压通气治疗,观察组在此基础上予以无创呼吸机辅助通气序贯高流量吸氧治疗。比较治疗前、治疗48 h末两组的循环功能(平均动脉压、心率、呼吸频率)、血气指标(动脉血氧分压、二氧化碳分压、动脉血氧饱和度、氧合指数)、血清指标(C-反应蛋白、B型尿钠肽)变化,并统计围治疗期指标(48 h内气管插管再插率、28 d病死率、重症加强护理病房住院时间、总住院时间)。结果治疗48 h末两组平均动脉压、心率、呼吸频率、二氧化碳分压、C-反应蛋白、B型尿钠肽水平较治疗前均显著降低(P<0.05),动脉血氧分压、动脉血氧饱和度、氧合指数均较治疗前均显著升高(P<0.05),观察组上述指标显著优于对照组(P<0.05)。观察组重症加强护理病房住院时间及总住院时间均显著短于对照组(P<0.05),两组48 h内气管插管再插率、28 d病死率比较差异无统计学意义(P>0.05)。结论无创呼吸机辅助通气序贯高流量吸氧治疗急性左心衰竭合并呼吸衰竭可有效促进患者循环功能及血气指标的恢复,促进C-反应蛋白、B型尿钠肽水平的降低,缩短住院时间。Objective To investigate the efficacy of non-invasive ventilator-assisted ventilation sequential high-flow oxygen inhalation on patients with severe acute left ventricular failure(ALVF)complicated with respiratory failure.Methods A total of 82 patients with severe ALVF complicated with respiratory failure were divided into an observation group(42 cases)and a control group(40 cases)according to random number table method.Both groups were given conventional treatments such as drainage,expectorant,anticoagulation,nutritional support and atomization inhalation,the control group was given non-invasive positive pressure ventilation on this basis,and the observation group was given non-invasive ventilator-assisted ventilation sequential high-flow oxygen inhalation on this basis.The changes of circulatory function[mean arterial pressure(MAP),heart rate(HR),respiratory rate],blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),arterial oxygen saturation(SaO_(2)),oxygenation index(OI)]and serum indexes[C-reactive protein(CRP),B-type natriuretic peptide(BNP)]were compared between the two groups before treatment and at the end of 48 hours of treatment,and the indexes(tracheal re-intubation rate within 48h,28d fatality rate,ICU stay,total hospital stay)during the peri-treatment period were counted.At the end of 48 hours of treatment,the MAP,HR,respiratory rate,PaCO_(2),CRP and BNP in the two groups were significantly decreased compared with those before treatment(P<0.05),while the PaO_(2),SaO_(2) and OI were significantly increased compared with those before treatment(P<0.05),and the above indicators in the observation group were significantly better than those in the control group(P<0.05).The ICU stay and total hospital stay in observation group were significantly lower than those in control group(P<0.05),but there were no statistically significant differences in the tracheal re-intubation rate within 48h and 28d fatality rate between the two groups(P>0.05).Conclusions N

关 键 词：重症 急性左心衰竭 呼吸衰竭 无创呼吸机 高流量吸氧 疗效 

分 类 号：R541.6[医药卫生—心血管疾病] R563.8[医药卫生—内科学]