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目的观察同时使用无创呼吸机辅助通气治疗对尿毒症并急性左心衰患者的疗效。方法对贵州省人民医院急诊内科门诊2013年11月至2016年3月63例确诊尿毒症并急性左心衰患者进行观察。将患者分为对照组[n=31,年龄(46.2±13.2)岁]及治疗组[n=32,年龄(47.2±14.8)岁]。对照组只进行常规吸氧、强心、利尿、扩血管治疗,治疗组在常规治疗同时进行无创呼吸机治疗。记录治疗前、治疗2 h末患者临床症状及心率(HR)、呼吸频率(RR)、收缩压(SBP)、舒张压(DBP)、动脉血氧分压(Pa O2)指标变化,2 h末血浆脑钠肽(BNP)、血乳酸(Lac)水平变化。结果治疗2 h末,与对照组比较,治疗组HR[(96.7±9.1)/min vs(106.6±10.3)/min]、RR[(21.0±1.6)/min vs(23.8±1.8)/min]、SBP[(140.1±9.2)mm Hg vs(148.5±19.0)mm Hg]、DBP[(86.2±6.4)mm Hg vs(98.8±10.2)mm Hg]、Pa O2[(96.6±5.7)mm Hg vs(87.2±7.7)mm Hg]、BNP[(1 721.0±794.6)ng/L vs(2 226.4±760.1)ng/L]、Lac[(3.50±1.27)mmol/L vs(4.74±1.42)mmol/L]均有改善(P<0.05)。治疗组急诊透析率明显低于对照组(χ~2=14.385,P<0.01)。治疗组治疗有效率高于对照组(χ~2=15.432,P<0.01)。结论同时使用无创呼吸机辅助治疗能安全、有效地缓解尿毒症并急性左心衰患者临床症状及改善心功能。
Objective To observe the curative effect of noninvasive ventilator assisted ventilation on uremic patients with acute left heart failure. Methods 63 patients diagnosed with uremia and acute left heart failure from November 2013 to March 2016 in Guizhou Provincial People’s Hospital Emergency Internal Medicine Clinic were observed. Patients were divided into control group [n = 31, age 46.2 ± 13.2 years] and treatment group [n = 32, age 47.2 ± 14.8 years]. The control group only routine oxygen, cardiac, diuretic, vasodilator treatment, the treatment group in the conventional treatment of non-invasive ventilator treatment. The changes of clinical symptoms and heart rate (HR), respiratory rate (RR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and arterial oxygen pressure (Pa O2) Plasma levels of brain natriuretic peptide (BNP), blood lactate (Lac) levels. Results Compared with the control group, HR [(96.7 ± 9.1) / min vs (106.6 ± 10.3) / min] and RR [(21.0 ± 1.6) / min vs (23.8 ± 1.8) / min) , SBP [(140.1 ± 9.2) mm Hg vs (148.5 ± 19.0) mm Hg], DBP [(86.2 ± 6.4) mm Hg vs (98.8 ± 10.2) mm Hg), Pa O2 [(96.6 ± 5.7) mm Hg vs (87.2 ± 7.7) mm Hg], BNP [(1721.0 ± 794.6) ng / L vs (2226.4 ± 760.1) ng / L] and Lac [(3.50 ± 1.27) mmol / L vs (4.74 ± 1.42) mmol / L] improved (P <0.05). The emergency dialysis rate in the treatment group was significantly lower than that in the control group (χ ~ 2 = 14.385, P <0.01). The effective rate of treatment group was higher than that of control group (χ ~ 2 = 15.432, P <0.01). Conclusion Concurrent use of non-invasive ventilator-assisted therapy can safely and effectively relieve the clinical symptoms and improve cardiac function in patients with uremia and acute left heart failure.