早期无创正压通气纠正急性左心衰竭所致严重低氧血症效果观察

目的观察早期无创正压通气（noninavasive positive pressure ventilation，NPPV）对急性左心衰竭所致严重低氧血症的治疗效果。方法40例急性左心衰（心功能Ⅳ）患者随机分为NPPV组和常规治疗组，两组均常规给予强心、利尿、镇静、扩血管等对症支持治疗，NPPV组在常规治疗的基础上采用双向气道正压呼吸机（BiPAP）经面罩双向正压通气治疗，常规治疗组则给予普通高浓度吸氧。观察治疗2小时后两组患者心率、呼吸、血压、脉搏、血氧饱和度（SaO2）、血气分析和临床症状体征的变化。结果NPPV组所有患者HR下降，呼吸困难症状缓解，生命体征平稳，PaO2、SaO2明显增高，缺氧程度得到有效改善，治疗总有效率100％（20／20）；常规治疗组总有效率70％（14／20）。结论重度左心衰患者在抗心衰药物治疗的同时使用BiPAP面罩双相气道正压无创通气可以较快纠正机体缺氧状况，改善心功能，缩短病程。

Noninvasive positive pressure ventilation for treatment of serious hypoxemia following acute left heart failure

Objective To observe the effect of early noninvasive positive pressure ventilation(NPPV) on the treatment of serious hypoxemia induced by acute left heart failure.Methods Forty patients with acute left heart failure were divided into two groups: conventional therapy group in which patients were given cardiotonics,diuretics,vasodilators,etc and NPPV group in which patients received noninvasive positive pressure ventilation in addition to conventional treatment.Systolic blood pressure,heart rate,respiratory rate, blood-gas analysis(pH,PaO_2,PaCO_2,SaO_2) and clinical signs were observed after treatment for 2 hours.Results After treatment,the clinical symptoms including tachycardia and dyspnea in patients in NPPV group were improved,the vital signs were stable,and PaO_2,SaO_2 went up.The total effective rate was 100%,which was only 70% in the conventional therapy group.Conclusion Early noninvasive positive pressure ventilation is one of the effective methods for the treatment of acute left heart failure with serious hypoxemia by improving cardiac function,decurtating course of the disease,and ameliorating hypoxia.