无创呼吸机辅助通气结合综合护理对急性左心衰的改善作用

目的 探讨无创呼吸机辅助通气(NIPPV)结合综合护理对急性左心衰的应用效果。方法 选取我院心病科2014年1月至2015年11月收治的109例急性左心衰患者,根据患者实际情况,按照处理方式不同分为对照组(36例)、NIPPV组(39例)和(NIPPV+综合护理)组(34例),对照组给予强心、利尿及血管扩张药物(如西地兰、呋塞咪、硝酸甘油或硝普钠等)治疗,同时给予鼻导管给氧4～6 L/min;NIPPV组在给予上述抗心衰药物治疗的同时采用NIPPV治疗,(NIPPV+综合护理)组在NIPPV组治疗基础上,并在治疗期间开展综合护理措施;观察治疗前及治疗后2h三组氨基末端B型脑钠钛前体(BNP),心率(HR),呼吸频率(R),动脉血(pH值、PaO₂、SaO₂)和HAMA得分等;并以电话或门诊随访1年,观察健康测量量表(SF-36)得分以评价三组治疗效果。结果 治疗2 h后,与治疗前相比,三组R、HR和BNP、PaO₂、SaO₂值均显著改善(P＜0.05),NIPPV组和(NIPPV+综合护理)组BNP、PaO₂、SaO₂值均显著优于对照组(P＜0.05),且(NIPPV+综合护理)组PaO₂、SaO₂值显著优于NIPPV组(P＜0.05);总体有效率NIPPV组为92.30%和(NIPPV+综合护理)组为97.06%均显著优于对照的86.11%(P＜0.05),NIPPV组和(NIPPV+综合护理)组治疗前及治疗后2 h的HAMA得分和随访1年后(SF-36)评分均显著优于对照(P＜0.05)。结论 在急性左心衰患者的治疗中,NIPPV治疗结合综合护理,可以迅速纠正低氧血症,改善心功能,减少并发症的发生,值得研究。

Improvement effect of non invasive positive pressure ventilation combined with integrated care on acute left heart failure

Objective To investigate the effect of Non Invasive Positive Pressure Ventilation (NIPPV) combined with integrated care on acute left heart failure (ALHF).Methods There were 109 cases of acute left heart failure patients in our hospital from January 2014 to November 2015,according to the actual situation of patients,and based the different treatment methods,whom were divided into group control (36 cases),group NIPPV (39 cases),and group (NIPPV+ Integrated Care) (34cases),in the control group received cardiac,diuretic and vasodilator drugs (such as cedilanid,katlex,nitroglycerin or sodium nitroprusside) treatment,while giving the nasal catheter oxygen 4-6L/min;in the group NIPPV given the drug therapy by NIPPV treatment,in the group (NIPPV+ Integrated Care),based on group NIPPV treatment,and carried out integrating care during treatment;Both the three groups treatment before and after treatment 2 hour,amino terminal B type natriuretic titanium precursor (BNP),heart rate (HR),respiratory rate (R),arterial blood (pH,PaO2,SaO2) and HAMA score were tested or recorded;and then using telephone or outpatient follow-up of 1 years, the health measurement scale (SF-36) score was evaluated the treatment effect of the two groups.Results Compared with before treatment,the three groups of R,HR and BNP,PaO2,SaO2 values were significantly improved at treatment after 2hour (P<0.05),and the BNP,PaO2 value of both group NIPPV and group (NIPPV+ Integrated Care) were significantly better than the control group (P<0.05),and th evalue PaO2 and SaO2 of group (NIPPV+ Integrated Care) were significantly better than group NIPPV;the 92.30% overall efficiency of the group NIPPV and 97.06% in group (NIPPV+ Integrated Care) were significantly better than that of the 86.11% in control group (P<0.05),and both group NIPPV and group (NIPPV+ Integrated Care) before and after treatment of 2hour and HAMA scores after 1 years of follow-up (SF-36) scores were significantly better than the control (P<0.05).Conclusions In the treatment of patients with acute left heart failure, NIPPV treatment combined with comprehensive care could be quickly correcting the hypoxia, and improving heart function, and reducing the incidence of complications, to some extent, it would be worth studying.