摘要
目的 回顾性研究 1999年 2月～ 2 0 0 2年 9月应用无创机械通气治疗的急性左心功能衰竭患者的临床资料 ,进一步探讨无创机械通气在治疗急性左心功能衰竭中的疗效及其适应证和安全性。方法 5 6例确诊为急性左心功能衰竭的患者分为无创通气组 2 6例和常规治疗组 30例 ;常规治疗组予常规抗心功能衰竭治疗辅以吸入高浓度氧疗 ;无创通气组患者加用无创通气治疗 ,压力设置吸气相压力为 (18.3± 1.6 )cmH2 O(16～ 2 0cmH2 O) ,呼气相压力为 (3.9± 0 .8)cmH2 O (3～ 5cmH2 O) ,呼吸频率设定为 2 0～ 30次 /min ,延迟时间为 5min。通气时间为发作后即开始 ,持续至症状缓解 ;分别记录各组患者治疗前及治疗后 15和 4 5min的呼吸、心率、血压、血气分析及症状、体征的变化。结果 无创通气组治疗后 15min血气指标、呼吸频率和心率明显改善(P <0 .0 1) ,其中动脉血氧分压 (PaO2 )和心率随通气时间的延长进一步好转 (P <0 .0 1) ;无创通气组治疗后 15min血pH值、动脉血二氧化碳分压、呼吸频率和心率与常规治疗组的差异有显著性 ;无创通气组治疗后 4 5min的PaO2 和呼吸频率较常规治疗组明显改善 (P <0 .0 5 )。结论 无创通气治疗心功能衰竭可以明显改善缺氧 ,并显著降低心率 ,减慢呼吸频率 。
Objective To appraise the accommodation and safety of noninvasive ventilation in acute left heart failure. Methods The clinical data during 1999.2～2002.9 were retrospectively reviewed. Among the 56 patients definitely diagnosed as having acute left heart failure, 26 were treated with BiPAP noninvasive ventilation besides the routine treatment of acute pulmonary edema while other 30 patients were only given concentration oxygen and routine treatment. The pressure set up of IPAP was at (18.3±1.6)(16～20 cm H 2O) and EPAP was at (3.9±0.8)(3～5 cm H 2O). Breathing frequency was set at 20～30 times/min, the delayed time was 5 min. Ventilation was started rapidly after diagnosis and lasted till relief of the symptoms. Heart rate, respiration rate, blood pressure, blood gas analysis, symptoms and signs were all recorded before and 15 min, 45 min after the ventilation. Results At 15 min after non invasive ventilation the respiration rate, heart rate, blood gas analysis of the ventilation group were significantly improved (P<0.01); PaO 2 and heart rate also improved by prolongation of the ventilation time (P<0.01), simultaneously the blood pH, PaCO 2, respiratory rate and heart rate in the ventilation group were much different from those of the routine treatment group. 45 min after treatment, the above parameters of the ventilation group improved much more than those of the routine treatment group (P<0.05). Conclusion Noninvasive ventilation with routine treatment in patients with acute pulmonary edema can improve the hypoxemia , slow down the heart and respiratory rates with rapid correction of hypoxemia and acidosis, and eventually decrease the probability of endotracheal intubation.
出处
《上海医学》
CAS
CSCD
北大核心
2004年第7期476-478,共3页
Shanghai Medical Journal
