微创医学

目的研究早期应用无创双水平气道正压(BiPAP)通气在治疗重度急性左心功能衰竭中的疗效。方法 86例重度急性左心衰(KillipⅢ～Ⅳ级)患者随机分为BiPAP组和常规治疗组各43例,两组均常规给予强心、利尿、镇静、扩血管等对症支持治疗。BiPAP组在常规治疗的基础上早期应用面罩无创双水平气道正压通气辅助治疗,常规治疗组则给予面罩高浓度吸氧。对两组治疗前后的临床症状、体征、血气、心率、血压等的变化进行对照分析。结果两组心率、血压、肺部啰音及动脉血气等指标与治疗前比较,均有显著性差异(P<0.05),3例无效,改为气管插管,其中1例死亡,治疗总有效率93.02%;常规治疗组死亡2例,总有效率76.74%,两组差异有统计学意义。结论重度急性左心衰患者在予抗心衰药物治疗的同时,早期应用BiPAP辅助治疗安全有效,能纠正机体缺氧状况,改善心功能,缩短病程。

Objective To estimate the effect of early noninvasive Bi-level positive pressure ventilation (BiPAP) in the treatment of severe acute left heart failure1.Methods 86 patients with severe acute left heart failure were divided into two groups:Bi-PAP group and control group(43 cases each).Patients in both groups were given conventional treatment with cardiotonics,diuretics,sedation,vasodilators,etc.The Bi-PAP group received early noninvasive facemask Bi-level positive pressure ventilation in addition to conventional treatment.Control group were treated by facemask with high level oxygen in addition to conventional treatment.Before and after treatment,the changes of clinical symptom,clinical signs,blood gas analysis (pH、PaCO2、PaO2/FiO2),heart rate,blood pressure were analyzed statistically.Results The clinical parameters (HR,RR,SBP,DBP) and arterial blood gas parameters in both groups were showed significant differences,as compared with those before treatment (P<0. 001).After treatment,there existed difference between the two groups in HR and PaO2/FiO2.The treatment failed in 3 patients and underwent tracheal intubation,among which,1 patients died,and the total effective rate of Bi-PAP group was 93.02%.While 2 patients died in the control group with a total effective rate of 76.74%,which showed statistical significance compared with that of the Bi-PAP group.Conclusion Based on anti-heart failure treatment,early noninvasive Bi-level positive pressure ventilation is one of the effective methods for the treatment of severe acute left heart failure by ameliorating hypoxia,improving cardiac function,and decurtating course of the disease.