对比BiPAP无创通气与经鼻高流量氧疗治疗不同分级老年急性左心衰竭伴低氧血症的疗效  

Comparison of the efficacy of BiPAP non-invasive ventilation and nasal high flow oxygen therapy in the treatment of acute left heart failure with hypoxemia in elderly patients with different grades

作　　者：费优生 张超 高洁 徐俊蛟 赵成刚 FEI You-sheng;ZHANG Chao;GAO Jie;XU Jun-jiao;ZHAO Cheng-gang(Department of Emergency,Nanxiang Hospital,Jiading District,Shanghai 201802,China)

机构地区：[1]上海市嘉定区南翔医院急诊科,上海市201802

出　　处：《中国心血管病研究》2024年第1期54-59,共6页Chinese Journal of Cardiovascular Research

基　　金：上海市嘉定区自然科学研究基金项目(JDKW-2021-0045)。

摘　　要：目的对比双水平正压(BiPAP)无创通气与经鼻高流量氧疗(HFNC)治疗不同分级老年急性左心衰竭伴低氧血症的疗效。方法选取2021年6月至2023年5月上海市嘉定区南翔医院急诊科收治的老年急性左心衰竭伴低氧血症患者180例作为研究对象,采用抽签法分为A组和B组,各90例,其中A组患者接受BiPAP无创通气,B组患者接受HFNC治疗。分别于抢救治疗后即刻、后6 h、24 h采集两组患者静脉血和动脉血,分别测定血清N末端B型利钠肽前体(NT-proBNP)、和肽素(Copeptin)和血气分析,了解各时段NT-proBNP、Copeptin和二氧化碳分压(PaO2)、血氧饱和度(SaO2)的水平,记录两组患者气管插管率及预后的结果。结果经治疗后,两组患者总有效率均为88.89%,但是B组中Ⅱ级和Ⅲ级患者有效率分别为90.70%、78.95%高于A组89.66%、88.89%,Ⅳ级患者有效率78.95%低于A组87.50%,但差异无统计学意义(P>0.05)。两组患者治疗后即刻、后6 h、24 h时,患者的NT-proBNP水平趋势为Ⅱ级<Ⅲ级<Ⅳ级(P<0.05),而Copeptin在不同分级患者之间整体差异不明显(P>0.05)。治疗后24 h内,两组患者NT-proBNP和Copeptin水平均降低,且A组中Ⅱ级和Ⅲ级患者NT-proBNP水平[(3561.16±126)pg/ml、(4681.23±245.33)pg/ml]高于B组中Ⅱ级和Ⅲ级患者[(3026.59±145.27)pg/ml、(4126.89±275.46)pg/ml],Ⅳ级患者者NT-proBNP水平低于B组[(5149.56±312.05)pg/ml比(5463.29±345.71)pg/ml,P<0.05],两组患者治疗后即刻、后6 h、24 h时,患者的PaO2和SaO2水平趋势均为Ⅱ级>Ⅲ级>Ⅳ级,且经治疗后24 h内,患者PaO2和SaO2水平均呈上升趋势。B组Ⅳ级患者治疗后24 h时PaO2水平低于A组Ⅳ级患者[(74.12±5.95)mmHg比(80.36±5.72)mmHg],Ⅱ级和Ⅲ级患者治疗后6 h和24 h时SaO2水平高于A组同级患者(P<0.05)。A组中进行插管患者共9例(10.00%),B组中共8例(8.89%),A组死亡3例(3.33%),B组死亡2例(2.22%)。两组患者插管率和死亡率之间差异无统计学意义(P>0.05)。结论BiPAP对Objective To compare the efficacy of biphasic positive airway pressure(BiPAP)non-invasive ventilation and high flow nasal oxygen therapy(HFNC)in the treatment of acute left ventricular failure with hypoxemia in elderly patients with different grades.Methods One hundred and eighty elderly patients with acute left heart failure and hypoxemia admitted to the emergency department of Shanghai Nanxiang Hospitals from June 2021 to May 2023 were selected as the research subjects.They were divided into Group A and Group B with 90 patients each using a lottery method.Group A received BiPAP non-invasive ventilation,and Group B received HFNC treatment.The venous and arterial blood from all the patients were collected immediately,6 hours,and 24 hours after rescue treatment;and the levels of N-terminal B-type natriuretic peptide precursor(NT-proBNP),copeptin,and blood gas analysis were measured,and the tracheal intubation rate and prognosis of the two groups of patients were record.Results After the treatment,the total effective rates of both groups were 88.89%.However,in Group B,the effective rates of GradeⅡand GradeⅢpatients were 90.70%and 78.95%,respectively,which were higher than those of 89.66%and 88.89%in Group A and the effective rates of GradeⅣpatients were 78.95%lower than that of 87.50%in Group A,but the differences were not statistically significant(P>0.05).At immediate,6 h,and 24 h after treatment,the trend of NT-proBNP levels in the two groups was gradeⅡ<gradeⅢ<gradeⅣ(P<0.05),while the overall difference in copeptin levels among patients of different grades was not significant(P>0.05).Within 24 hours after treatment,the levels of NT proBNP and copeptin in both groups of patients decreased,and the NT-proBNP levels in gradeⅡandⅢpatients in Group A[(3561.16±126)pg/ml,(4681.23±245.33)pg/ml]were higher than those in gradeⅡandⅢpatients in group B[(3026.59±145.27)pg/ml,(4126.89±275.46)pg/ml],while the NT-proBNP level in gradeⅣin Group A was lower than that in group B[(5149.56±312.05)pg/ml vs.(5

关 键 词：无创通气 经鼻高流量氧疗 急性左心衰竭 低氧血症 和肽素 

分 类 号：R541.6[医药卫生—心血管疾病]