无创呼吸机辅助振动排痰对ICU急性心力衰竭患者心功能指标的影响  

The effect of non-invasive ventilator assisted vibration sputum evacuation on cardiac function indicators in intensive care unit patients with acute heart failure

作　　者：郦文泽[1] 汪晓琴 张丽婷 丁丽琴[1] 孔祥伟 汪闰琴 Li Wenze;Wang Xiaoqin;Zhang Liting;Ding Liqin;Kong Xiangwei;Wang Runqin(Department of Psychiatry and Geriatric Intensive Care Medicine,Tongde Hospital of Zhejiang Province,Hangzhou 310012,Zhejiang,China)

机构地区：[1]浙江省立同德医院精神老年重症医学科,浙江杭州310012

出　　处：《中国中西医结合急救杂志》2024年第4期442-446,共5页Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care

基　　金：浙江省中医药科技计划项目(2019ZB025)。

摘　　要：目的观察无创呼吸机辅助振动排痰对重症监护病房(ICU)急性心力衰竭患者心功能指标水平的影响.方法选择2020年9月至2023年3月在浙江省立同德医院ICU接受治疗的120例急性心力衰竭患者作为研究对象.将患者按随机数字表法分为对照组和试验组,每组60例.两组患者均给予常规对症治疗和无创呼吸机辅助通气,对照组给予常规护理干预,试验组给予无创呼吸机辅助振动排痰干预.记录两组患者干预2周后动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、脉搏血氧饱和度(SpO_(2))、呼吸频率(RR)、心率、血压、中心静脉压、血清中和超声下心功能指标及预后情况.结果两组干预后PaO_(2)、SpO_(2)、左室射血分数(LVEF)均较干预前明显升高,而PaCO_(2)、RR、心率、血压、中心静脉压、N末端脑钠肽前体(NT-proBNP)、心肌肌钙蛋白T(cTnT)、左室收缩期末内径(LVESD)、左室舒张期末内径(LVEDD)均较干预前明显降低(均P<0.05).与对照组比较,试验组干预后PaO_(2)、SpO_(2)、血压、中心静脉压、LVEF均明显升高[PaO_(2)(mmHg,1 mmHg≈0.133 kPa):68.24±5.81比59.63±6.86,SpO_(2):0.95±0.03比0.87±0.04,收缩压(mmHg):116.05±4.11比104.13±3.95,舒张压(mmHg):68.19±4.13比62.85±4.12,中心静脉压(mmHg):9.42±1.29比8.14±1.42,LVEF:0.49±0.05比0.43±0.04,均P<0.05],PaCO_(2)、RR、心率、NT-proBNP、cTnT、LVESD、LVEDD均明显降低[PaCO_(2)(mmHg):42.12±4.08比52.13±4.61,RR(次/min):18.85±1.75比21.54±2.51,心率(次/min):89.53±8.14比101.11±10.26,NT-proBNP(ng/L):1687.25±589.67比2145.36±751.03,cTnT(ng/L):70.58±5.15比81.45±6.89,LVESD(mm):34.51±3.11比38.89±3.55,LVEDD(mm):46.11±3.22比49.74±3.75,均P<0.05].试验组机械通气时间、ICU住院时间、肺部感染缓解时间均较对照组明显缩短[机械通气时间(h):72.14±10.06比78.96±12.97,ICU住院时间(d):10.74±2.15比12.88±3.26,肺部感染缓解时间(d):3.58±0.79比5.14±1.12,均P<0.05],肺部感染�Objective To observe the effect of non-invasive ventilator assisted vibration sputum evacuation on the level of cardiac function indicators in patients with acute heart failure in the intensive care unit(ICU).Methods A total of 120 patients with acute heart failure who received treatment in the ICU of Tongde Hospital of Zhejiang Province from September 2020 to March 2023 were selected as the study subjects.The patients were randomly divided into a control group and an experimental group using a random number table method,with 60 patients in each group.A total of 120 patients were treated with conventional symptom therapy and non-invasive ventilation.The control group received routine nursing intervention,while the experimental group received non-invasive ventilator assisted vibration sputum evacuation.Arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide(PaCO_(2)),pulse oxygen saturation(SpO_(2)),respiratory rate(RR),heart rate,blood pressure,central venous pressure,serum and ultrasound cardiac function indicators,and prognosis of two groups of patients were recorded after 2 weeks of intervention.Results After the intervention,PaO_(2),SpO_(2),and left ventricular ejection fraction(LVEF)were significantly increased in both groups,while PaCO_(2),RR,heart rate,blood pressure,central venous pressure,N-terminal pro-brain natriuretic peptide(NT-proBNP),cardiac troponin T(cTnT),left ventricular end-systolic diameter(LVESD),and left ventricular end-diastolic diameter(LVEDD)were significantly decreased compared to before the intervention(all P<0.05).Compared with the control group,the experimental group showed significant increases in PaO_(2),SpO_(2),blood pressure,central venous pressure,and LVEF after intervention[PaO_(2)(mmHg,1 mmHg≈0.133 kPa):68.24±5.81 vs.59.63±6.86,SpO_(2):0.95±0.03 vs.0.87±0.04,systolic blood pressure(mmHg):116.05±4.11 vs.104.13±3.95,diastolic blood pressure(mmHg):68.19±4.13 vs.62.85±4.12,central venous pressure(mmHg):9.42±1.29 vs.8.12±4.12,LVEF:0.49±

关 键 词：振动排痰 无创呼吸机 急性心力衰竭 重症监护病房 肺部感染 

分 类 号：R541.6[医药卫生—心血管疾病]