无创正压通气在老年急性心肌梗死并左心衰竭的临床应用研究

目的 观察无创正压通气(NPPV)对老年急性心肌梗死并左心衰竭患者的临床疗效.方法 选择70例老年急性心肌梗死并左心衰竭患者,分为观察组与对照组各35例,两组患者均给予抗凝、扩冠等常规治疗,观察组给予NPPV,对照组给予高浓度面罩吸氧,2h及24 h后对比两组血流动力学及血气分析参数,并比较两组患者临床预后.结果 治疗2h后,观察组患者HR、RR低于治疗前(P＜0.05),PaO2、pH高于治疗前(P＜0.05),PaCO2与治疗前无明显差异(P＞0.05).对照组HR、RR、PaCO2及pH同治疗前无明显差异,PaO2高于治疗前(P＜0.05).治疗2h后,观察组RR低于对照组(P＜0.05),PaO2高于对照组(P＜0.05).治疗24h后,两组HR、RR低于治疗前(P＜0.05),PaO2、pH高于治疗前(P＜0.05),PaCO2与治疗前无明显差异(P＞0.05).两组间HR、RR、PaO2、PaCO2及pH无显著差异(P＞0.05).观察组死亡率、气管插管率低于对照组(P＜0.05).观察组患者住院时间少于对照组(P＜0.05).结论 NPPV是抢救老年急性心肌梗死合并左心衰竭患者的有效措施,能够改善临床治疗效果,降低死亡率.

Application of noninvasive positive pressure ventilation on gerontal pa- tients with acute myocardial infarction complicated left heart failure

Objective To investigate the clinical curative effect of noninvasive positive pressure ventilation （NPPV） on gerontal patient with acute myocardial infarction （AMI） complicated left heart failure. Methods A total of 70 cases of gerontal patient with acute myocardial infarction complicated left heart failure were selected and randimzed into obser- vation groups and control groups, all patients taken common treatment with anticoagulation and expanding coronary artery,and so on,patients in observation groups taken NPPV and patients in observation groups taken high concentra- tion oxygen inspired with face mask,and parameter of hemodynamics and blood gas analysis were contrasted between observation groups and control groups after 2 hours, and clinical prognosis were contrasted between observation groups and control groups. Results At 2 hours after treatment, HR and RR was lower than before treatment （P 〈 0.05）, and Pa02 and pH was higher than before treatment in observation groups （P 〈 0.05）, PaC02 was invariant in observation groups （P 〉 0.05）. HR, RR, PaC02 and PH was identical between at 2 hours after treatment and before treatment in control groups （P 〉 0.05）, Pa02 was lower than before treatment in control groups （P 〈 0.05）. At 2 hours after treat- ment, RR was lower and Pa02 was higher in observation groups than in control groups （P 〈 0.05）. At 24 hours after treatment, HR and RR was lower than before treatment （P 〈 0.05）, and Pa02 and pH was higher than before treatment in two groups （P 〈 0.05）, PaC02 was invariant in two groups （P 〉 0.05）, HR, RR, Pa02, PaC02 and pit were indebtical between observation groups and control groups （P 〉 0.05）. Death rate and tracheal intubation rate was lower in ob- servation groups to in control group （P 〈 0.05）, time in hospital was short in observation groups to in control groups （P 〈 0.05）. Conclusion NPPV is effective salvage way in gerontal patient with acute myocardial infarction complicated left heart failure, and can improve clinical clinical curative effect and decrease death rate.