摘要
目的探讨急性心肌梗死（AMI）合并急性左心衰竭和呼吸衰竭患者早期应用机械通气治疗的临床经验。方法回顾性分析2003年9月至2007年10月应用机械通气治疗AMI合并急性左心衰竭和呼吸衰竭患者26例，观察治疗前后所有患者呼吸、心率、pH值、动脉血氧分压（PaO2）、二氧化碳分压（PaCO2）、氧合指数（PaO2／FiO2）、心功能分级变化及有效率；根据开始使用机械通气时间，分为早期应用组（A组，n=14例）及非早期应用组（B组，n=12），比较两组病情好转时间、机械通气时间、有效率和病死率。结果治疗后24例存活者的心功能均有改善，由原来的心功能Ⅳ级改善至心功能I～Ⅱ级，呼吸、心率显著减慢，pH值、PaO2、PaC02、PaO2／FiO2均明显改善。A组治疗后2、24小时呼吸、Pa02、PaC02、Pa02／Fi02分别为（26．7±5．9）次／min、（16．2±3．0）次／min，（85±6）mmHg（1mmHg=0．133kPa）、（96±6）mmHg，（42．8±6．1）mmHg、（38．0±2．8）mmHg，（252±24）mmHg、（302±22）mmHg；病情好转时间、通气时间分别为（16±5）小时，（26±7）小时。与B组比较，差异有统计学意义（P〈0．05）。结论早期应用机械通气对改善AMI合并急性左心衰竭和呼吸衰竭的病情是非常重要的。
Objective To discuss the clinical experience of early mechanical ventilation in treating acute myocardial infarction（AMI） patients complicating with acute left heart failure and respiratory failure. Methods Totally 26 patients with AMI complicating with acute left heart failure and respiratory failure,admitted from September 2003 to October 2007,received mechanical ventilation treatment, and were retrospectively studied. The changes of respiratory rate, heart rate, pH, PaO2 , PaCO2 ,PaO2/FiO2 ratio, cardiac function before and after mechanical ventilation application were compared. According to the application time of mechanical ventilation,26 patients were divided into two groups： early mechanical ventilation application group（group A, n = 14） and non-early mechanical ventilation application group （group B, n = 12）. The time to improve the symptoms, the application time of mechanical ventilation and mortality were compared between two groups. Results In 24 of the 26 patients who survived, cardiac function was improved from Killip class Ⅳ to Ⅰ-Ⅱ, respiratory rate and heart rate decreased, pH,PaO2 and PaO2/FiO2 ratio were significantly increased and PaCO2 significantly decreased. At 2 and 24 h after treating in group A, respiratory rate was （26.7± 5.9） times/min,（16.2±3.0） times/min,PaO2 was （85±6） mm Hg（1 mm Hg=0. 133 kPa）,（96±6） mm Hg, PaCO2 was （42.8±6.1） mm Hg,（38.0±2.8） mm Hg,PaO2/FiO2 ratio was （252±24） mm Hg,（302±22） mm Hg. The time needed to improve the symptoms was（16 ± 5） h, and the application time of mechanical ventilation was （26 ±7） h. There were significant difference between group A and B （ P 〈 0.05）. Conclusion Early mechanical ventilation is essential management in treating AMI patients complicating with acute left heart failure and respiratory failure.
出处
《临床荟萃》
CAS
2009年第15期1299-1301,共3页
Clinical Focus
关键词
心肌梗死
心室功能障碍
左
呼吸功能不全
呼吸
人工
myocardial infarction
ventricular dysfunction, left
respiratory insufficiency
respiration, artificial
