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目的 :探讨老年显性吸入性肺炎诱导急性左心衰的临床特征、演变过程和治疗方法。方法 :对 9例老年患者因显性吸入性肺炎而发生急性左心衰时 ,动态观测气促评分、中心静脉压 (CVP)、氧合指数及其处置后的改变 ;处置包括祛除诱因、吸氧、联合应用抗生素和对症处理 ,并及时行纤支镜气道内吸除吸入物、分泌物等综合治疗 ,同时予强心、利尿和扩血管治疗 ,必要时行无创机械辅助通气。结果 :9例老年患者都伴有心血管基础疾病 ;所有患者在吸入发生 6小时内 ,气促评级显著增加 (P <0 0 1) ;而pH、PaO2 、氧合指数均显著降低 (P <0 0 5或 0 0 1) ;并急性左心衰发生后出现Ⅰ型呼衰 ,PaO2 <60mmHg、氧合指数 <3 0 0mmHg ,CVP显著升高。经处理在吸入发生 12小时内 ,各项观察指标均显著改善 ,大部分 2 4小时缓解 ;其中 4例需行无创机械辅助通气 ,2例进展为ARDS。结论 :老年人发生显性吸入性肺炎时 ,急性左心衰者除严重气促和氧合障碍外 ,伴有CVP的显著升高 ;在综合治疗基础上 ,同时抗心衰治疗 ,必要时予辅助通气 ;CVP可作为老年显性吸入性肺炎患者液体管理和心功能监测的手段。
Objective: To investigate the clinical features, evolution and treatment of acute left heart failure induced by elderly patients with overt aspiration pneumonia. Methods: Ninety elderly patients with acute left heart failure due to dominant aspiration pneumonia were assessed with dynamic assessment of shortness of breath, central venous pressure (CVP), oxygenation index and their changes after treatment. Disposal included dispelling inducement, suction Oxygen, combined antibiotics and symptomatic treatment, and timely bronchoscopy bronchial inhalation, secretions and other comprehensive treatment, at the same time to cardiac, diuretic and vasodilator treatment, if necessary, noninvasive mechanical ventilation. Results: All the 9 elderly patients were associated with cardiovascular diseases. All patients had a significant increase in the rating of breathlessness within 6 hours of inhalation (P <0.01), while the values of pH, PaO2 and oxygenation index decreased significantly (P <0 0 5 or 0 0 1); type Ⅰ respiratory failure occurred after acute left heart failure, PaO2 <60mmHg, oxygenation index <300mmHg, CVP increased significantly. Within 12 hours after inhalation, all the indexes were significantly improved, most of which were relieved in 24 hours. Among them, 4 patients needed noninvasive mechanical ventilation and 2 patients developed ARDS. Conclusion: In the elderly with dominant aspiration pneumonia, acute left heart failure in addition to severe shortness of breath and oxygenation disorders, accompanied by a significant increase in CVP; on the basis of comprehensive treatment, while anti-heart failure treatment, if necessary Assisted ventilation; CVP can be used as a measure of fluid management and cardiac function monitoring in elderly patients with overt aspiration pneumonia.