无创正压通气在急性心力衰竭中的临床应用

目的:评价无创正压通气(NIPPV)治疗急性心力衰竭(AHF)的效果。方法:将60例AHF患者随机分为2组,对照组采用常规抗心力衰竭治疗;治疗组除常规治疗外加用NIPPV治疗。观察2组患者治疗前、治疗2 h和8 h后的临床表现及心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、中心静脉压(CVP)、动脉血气等变化。随访出院后6个月内因心力衰竭再次发作住院情况。结果:治疗组患者在NIPPV后心功能明显改善,治疗效果高于对照组(P<0.05);2组患者治疗2 h和8 h后的HR、RR、动脉血氧分压(PaO₂)与血氧饱和度(SaO₂)均优于治疗前(P<0.01)。治疗组治疗前、治疗2 h和8 h后二氧化碳分压与对照组差异均无统计学意义(P>0.05);PaO₂、SaO₂、CVP较对照组升高(P<0.05~P<0.01);HR、RR和MAP均较对照组下降(P<0.05~P<0.01)。随访6个月内2组因再次心力衰竭发作住院率差异无统计学意义(P>0.05)。结论:NIPPV可明显改善AHF的低氧血症和心功能,是救治AHF的一种安全有效的方法。

The clinical application of the noninvasive positive pressure ventilation in acute heart failure

Objective:To evaluated the clinical effects of the noninvasive positive pressure ventilation(NIPPV) in the treatment of acute heart failure( AHF) . Methods:Sixty patients with AHF were randomly divided into the control group and treatment group. The control group were treated with routine anti-heart failure therapy, and the treatment group were treated with NIPPV combined with routine therapy. The changes of clinical symptoms,heart rate( HR) ,respiratory rate( RR) ,mean arterial pressure( MAP) ,central venous pressure( CVP) , arterial blood gas [ partial pressure of oxygen ( PaO2 ) , partial pressure of oxygen ( PaCO2 ) and oxygen saturation ( SaO2 ) ] in two groups were observed before treatment and after 2 and 8 hours of treatment. The rehospitalization conditions of patients caused by heart failure were followed up after 6 months of discharge. Results:The cardiac function in treatment group treated with NIPPV was significantly improved,the effect of which was better than that in control group(P<0. 05). After 2 and 8 hours of therapy, the levels of HR,RR,PaO2 and SaO2 in treatment group were better than those in control group(P<0. 01). The difference of the PaCO2 level in treatment group between before treatment and after 2 and 8 hours of therapy was not statistically significant(P >0. 05). Compared with the control group,the levels of PaO2,SaO2 and CVP in treatment group increased(P<0. 05 to P<0. 01),and the levels of HR,RR and MAP in treatment group decreased(P<0. 05 to P<0. 01). The difference of the rehospitalization rate between two groups caused by heart failure was not statistically significant during the six months of following-up(P>0. 05). Conclusions:NIPPV can obviously improve the hypoxemia and cardiac function in patients with AHF,which is a kind of safe and effective method in the treatment of AHF.