论文部分内容阅读
目的:观察双水平正压无创通气(BiPAP)治疗急性左心衰并发呼吸衰竭的临床效果。方法:随机将急性左心衰患者30例分为采用无创通气和有创通气治疗的两组,记录治疗前后呼吸力学、血流动力学及血气分析各参数。结果:无创通气组治疗1h后,pHa(7.42±0.048)显著高于治疗前(7.29±0.018),Lac(2.72±0.76mmol/L)显著低于治疗前(3.98±1.04 mmol/L),PaO_2(80.6±10.3 mm Hg)显著高于治疗前(47.5±6.28 mm Hg),PaCO_2(37.8±3.63 mm Hg)显著低于治疗前(50.3±5.74 mm Hg),HR(108.3±8.9次/min)显著低于治疗前(128.2±12.3次/min),MAP(97.31±2.62 mm Hg)显著低于治疗前(105.85±5.79 mmHg)(P均<0.01),并且持续通气4 h和24 h后,部分指标仍继续好转。无创通气组和有创通气组PaO_2、pHa、PaCO_2、Lac治疗前和治疗4 h前后差异均无显著性(P均>0.05)。结论:针对不同诱因引起急性左心衰并发呼吸衰竭的患者,在内科治疗的基础上,果断地使用BiPAP治疗,能通过增加氧供,使患者低氧症状迅速缓解,效果与有创通气无差异,还可避免气管插管,减少呼吸机相关性肺损伤,并发症减少,死亡率降低,有效提高了急诊的抢救能力。
Objective: To observe the clinical effect of bi-level positive pressure non-invasive ventilation (BiPAP) on acute left heart failure complicated with respiratory failure. Methods: Thirty patients with acute left heart failure were randomly divided into two groups: non-invasive ventilation and invasive ventilation. Respiratory mechanics, hemodynamics and blood gas analysis parameters were recorded before and after treatment. Results: Compared with before treatment (2.72 ± 0.76 mmol / L), Lac (2.72 ± 0.76 mmol / L) was significantly lower than that before treatment (7.42 ± 0.048), PaO2 (80.6 ± 10.3 mm Hg) was significantly higher than that before treatment (47.5 ± 6.28 mm Hg), PaCO_2 (37.8 ± 3.63 mm Hg) was significantly lower than that before treatment (50.3 ± 5.74 mm Hg), HR (108.3 ± 8.9 times / min) Significantly lower than before treatment (128.2 ± 12.3 times / min), MAP (97.31 ± 2.62 mm Hg) was significantly lower than before treatment (105.85 ± 5.79 mmHg) (P all <0.01), and continued ventilation for 4 h and 24 h, Some indicators still continue to improve. PaO2, pHa, PaCO2, Lac in non-invasive ventilation group and invasive ventilation group had no significant difference before and after treatment for 4 h (P all> 0.05). Conclusion: For patients with acute left heart failure complicated with respiratory failure due to different causes, the decisive use of BiPAP on the basis of medical treatment can rapidly relieve the symptoms of hypoxia in patients with hypoxia, the effect is no different from invasive ventilation , But also to avoid tracheal intubation, reduce ventilator-associated lung injury, reduce complications, reduce mortality and effectively improve the emergency rescue capabilities.