乌司他丁联合无创通气治疗急性难治性左心功能衰竭疗效观察

目的：观察乌司他丁联合无创通气治疗难治性左心功能衰竭的效果与安全性。方法：将2010年8月至2013年8月佛山市第二人民医院收治的84例基础心脏病为冠心病的难治性左心功能衰竭的患者随机分为观察组（40例）和对照组（44例），均使用无创通气，观察组联合应用乌司他丁，对照组则仅予常规治疗，比较两组的脑型钠尿肽（BNP）变化、左室射血分数（LVEF）变化、血气分析结果，使用无创通气时间、是否改用气管插管、重症科住院时间等。结果：观察组24、72 h BNP的下降百分比明显高于对照组（ P＜0.05），观察组与对照组24 h 氧分压（ PaO2）、二氧化碳分压（ PaCO2）比较，差异有统计学意义（ P＜0.05）。观察组7 d 左室射血分数（ LVEF）高于对照组（ P＜0.05）。观察组使用无创通气时间、重症科住院时间明显短于对照组（ P＜0.05）。观察组改用气管插管机械通气率、住院死亡率低于对照组，但差异无统计学意义（ P＞0.05）。结论：难治性左心功能衰竭患者联合使用乌司他丁与无创通气有利于心功能的恢复，能改善氧合、二氧化碳排出、左室收缩功能，缩短重症科住院治疗，但未证实是否降低住院死亡率。

Efficacy of ulinastatin combined with noninvasive ventilation in patients with acute intractable left heart failure

Objective：To investigate the effects and safety of ulinastatin combined with noninvasive ventilation in the treatment of intractable left heart failure. Methods： Eighty-four patients with acute intractable left heart failure, who were hospitalized in Foshan Second Municipal People’ s Hospital between August 2010 and August 2013, were randomly divided into the observation group （ n=40） and control group （ n=44） . Both groups of patients were received noninvasive ventilation. The observation group received ulinastatin combined with noninvasive ventilation. And the control group only received conventional treatment. The changes of brain natriuretic peptide （BNP）, left ventricular ejection fraction （LVEF）, blood gas analysis noninvasive ventilation time, tracheal intubation （ with/without） , and CCU hospitalized time in the two groups were compared. Results：The decline percentage of BNP in the observation group at 24 h and 72 h was significantly higher than that in the control group （ P〈0.05） . There were statistically significant differences in blood oxygen partial pressure （ PaO2 ） and partial pressure of carbon dioxide （ PaCO2 ） at 24 h between the observation group and the control group （ P〈0.05） . The LVEF score in the observation group at 7d was significantly higher than that in the control group （ P〈0.05） . And the rate of using mechanical noninvasive ventilation and hospitalization mortality were significantly lower than those in the control group, with no statistically significant difference （ P〉0. 05 ） . Conclusion：Ulinastatin combined with noninvasive ventilation favors the relieve of cardiac function, which can improve oxygenation and left ventricular systolic function, promote the carbon dioxide discharge, and shorten the CUU hospitalization time. However, whether it can reduce the hospitalization mortality has not been verified.