早期有创机械通气治疗急性左心衰竭时机选择的临床研究

【摘要】 目的 探讨急性左心衰竭治疗中有创机械通气的应用时机。 方法 32例急性左心衰患者中17例在发病起始时采用无创机械通气（无创组），15例在起始时采用气管插管有创机械通气（有创组）。观察比较2组患者机械通气后0.5、1、3h症状缓解人数、住院病死率、呼吸频率（RR）、动脉血氧分压p(O2)]、心率（HR）、平均动脉压（MAP）。 结果 无创组10例患者在0.5h内缓解，7例未缓解者改行气管插管机械通气，其中3例在0.5~1h缓解，4例死亡；有创组14例在0.5h内缓解，1例在0.5~1h缓解，无死亡。有创组0.5h内缓解人数多于无创组（P=0.041）；2组0.5~1h缓解人数（P=1.000）和病死（P=0.104）差异均无统计学意义。2组RR、HR均随治疗时间增加而降低，p(O2)、MAP均随时间增加而增加；0.5、1h时有创组RR低于无创组，0.5h时有创组p(O2)、MAP高于无创组，0.5、3h时有创组HR低于无创组（均P＜0.05）。 结论 应用无创机械通气治疗0.5h症状不缓解时应尽早改用有创机械通气。

Timing of Invasive Mechanical Ventilation in Patients with Acute Left Heart Failure

Abstract]ObjectiveTo investigate the various occasions of invasive mechanical ventilation in patients with acuteleft heart failure.MethodsThirty-two patients with acute severe left heart failure were divided into two groups:17patients were treated with non- invasive mechanical ventilation (non- invasive mechanical ventilation group) and15patients were treated with invasive mechanical ventilation (invasive mechanical ventilation group). The respiratory rate (RR), arterial oxy?gen partial pressurep(O2), heart rate (HR) and mean arterial pressure (MAP) were observed after treatment for 0.5h,1h and3h in two groups of patients. The in-hospital mortality was compared between two groups.Results Ten patients of non-in?vasive mechanical ventilation group were in remission after0.5h,7cases without remission switched to endotracheal intubation for invasive mechanical. And 3of them were in remission in0.5~1h,4of them dead. Fourteen patients in invasive mechanical ventilation group were in remission after0.5h, one case was in remission after0.5~1h and no dead in this group.There were more patients in remission after0.5h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P=0.041). There were no significant differences in the number of patients in clinical remission after 0.5~1h and mortality between two groups. The values of RR and HR were decreased with the increasing treatment time in two groups. The values of p(O2) and MAP were increased with the increasing treatment time in two groups. There was a significantly lower RR at0.5h and1h in invasive mechanical ventilation group than that of non-invasive mechanical ventilation group (P<0.05). The values of p(O2) and MAP were significantly higher at 0.5h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P<0.05). The levels of HR at0.5h and3h were significantly lower in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P<0.05).Conclusion Invasive mechanical ventilation should be used as soon as possible if non-invasive mechanical ventilation can not alleviate the symptoms in patients more than0.5hours.