论文部分内容阅读
目的观察无创机械通气(NPPV)治疗重症急性左心衰竭的临床效果。方法33例重症急性左心衰竭患者在常规吸氧、药物治疗的基础上,使用呼吸机予以面罩无创机械通气治疗,选择压力支持+呼气末正压(PSV+PEEP)通气模式。观察NPPV组与常规治疗(RT)组患者在治疗前后临床症状改善情况、心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血气分析(pH、PaO2、PaCO2、SpO2)及病死率和住院时间。结果NPPV组患者在实施机械通气2h后肺部啰音明显减少或消失。2h后复查血气分析,结果显示全部患者均有不同程度的好转。有3例患者终因心衰不能纠正而死亡。与常规治疗组及治疗前相比,NPPV组机械通气治疗后,患者呼吸困难明显改善,生命体征很快稳定,血气分析指标明显好转(P均<0.05)。两组病死率、住院时间比较差异均有统计学意义(P<0.05)。结论NPPV治疗重症急性左心衰竭能迅速改善患者的临床症状和低氧血症,可以提高抢救成功率,缩短住院时间,是抢救重症急性左心衰竭安全有效的辅助措施。
Objective To observe the clinical effect of noninvasive mechanical ventilation (NPPV) in the treatment of severe acute left heart failure. Methods 33 cases of severe acute left heart failure patients were treated with maskless mechanical ventilation on the basis of routine oxygen inhalation and drug therapy. Pressure support and positive end expiratory pressure (PSV + PEEP) ventilation mode were selected. The changes of clinical symptoms, heart rate (HR), respiratory rate (RR), mean arterial pressure (MAP), blood gas analysis (pH, PaO2, PaCO2 and SpO2) and the incidence of death before and after treatment were observed in NPPV group and conventional RT group Rate and length of stay. Results In the NPPV group, pulmonary rales significantly reduced or disappeared after 2 hours of mechanical ventilation. After 2h blood gas analysis review, the results showed that all patients have varying degrees of improvement. Three patients eventually died of heart failure due to failure to correct. Compared with the conventional treatment group and before treatment, the patients with NPPV had better dyspnea, stable vital signs and better blood gas analysis (P <0.05). There was significant difference between the two groups in case fatality rate and hospital stay (P <0.05). Conclusion NPPV treatment of severe acute left heart failure can rapidly improve the clinical symptoms and hypoxemia in patients. It can improve the success rate of rescue and shorten the length of hospital stay, which is safe and effective in rescue of severe acute left heart failure.