无创呼吸机辅助治疗时机对老年急性左心衰竭并发呼吸衰竭患者的影响研究

目的：探讨无创呼吸机辅助治疗时机对老年急性左心衰竭并发呼吸衰竭患者的影响。方法：2012年9月到2017年2月选择在我院ICU诊治的老年左心衰竭并发呼吸衰竭患者106例作为研究对象，按照入院顺序，根据随机信封抽签原则分为观察组与对照组各53例，两组都建立人工气道进行有创机械通气，观察组在呼吸泵衰竭改善会改用无创呼吸机辅助治疗，对照组只有在符合撤机标准时予撤机。结果：治疗后观察组与对照组的总有效率分别为98.1%和86.8%，观察组优于对照组(P<0.05)。治疗后两组的MAP、RR、pH、PaO2与PaCO2值对比差异都无统计学意义(P>0.05)。观察组的ICU住院时间、总住院时间、有创通气时间、总机械通气时间都明显少于对照组(P<0.05)。观察组住院期间的呼吸机相关性肺炎、气道狭窄、气道阻塞等并发症发生率为3.8%，对照组为20.8%，观察组并发症发生情况低于对照组(P<0.05)。结论：以呼吸泵衰竭改善作为无创呼吸机辅助治疗老年急性左心衰竭并发呼吸衰竭并不影响患者的血气指标，可提高治疗效果，缩短患者的通气时间与住院时间，减少并发症的发生，有很好的应用价值。

Effects of time of non-invasive ventilator assisted therapy on elderly patients with acute left heart failure combined with respiratory failure

Objective: To investigate the effects of the time of non-invasive ventilator assisted therapy on elderly patients with acute left heart failure combined with respiratory failure. Methods: From September 2012 to February 2017, 106 patients with acute left heart failure combined with respiratory failure in our hospital ICU diagnosis and treatment were selected as the research object, all the patients were randomly divided into observation group and control group of 53 patients accorded to the order of admission and the random lottery envelopes, two groups were given the artificial airway invasive mechanical ventilation, the observation group was used the noninvasive ventilator therapy when the respiratory pump failure were improvement, the control group was evacuated only when it met the evacuating criteria. Results: After treatment, the total effective rates in the observation group and the control group were 98.1% and 86.8%, respectively, and the total effective rate in the observation group was better than that of the control group (P<0.05). The MAP, RR, pH, PaO2 and PaCO2 values compared between the two groups after treatment were not statistically significant (P>0.05). The invasive ventilation time, the total mechanical ventilation time, the ICU hospitalization time and the total hospitalization time in the observation group were significantly less than those in the control group (P<0.05). The incidence of ventilator-associated pneumonia, airway stenosis and airway obstruction was 3.8% in the observation group, so that was 20.8% in the control group, and the observation group was lower than that in the control group (P<0.05). Conclusion: The noninvasive ventilator therapy in elderly patients with acute left heart failure combined with respiratory failure when the respiratory pump failure improve does not affect the blood gas index, it can improve the therapeutic effect, shorten the duration of ventilation and hospitalization time of patients, reduce the incidence of complications, so it has good values.