目的 观察无创正压通气治疗急性左心衰竭合并低氧血症患者的疗效.方法 将62例急性左心衰竭合并低氧血症患者随机分为治疗组31例和对照组31例,两组均给予常规内科治疗,治疗组应用无创正压通气治疗,分别监测两组患者治疗前、后的血气分析指标、B型脑钠肽(BNP)、临床表现等变化.结果 治疗组临床症状缓解时间[(33.7 ±7.9) min]明显短于对照组[(55.9±12.1) min],两组比较差异有统计学意义(t=8.554,P ＜0.01).治疗组治疗前心率、呼吸频率、平均动脉压(MAP)、pH值、血氧饱和度(SaO2)、动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、B型脑钠肽(BNP)分别为(133.89 ±5.45)次/min、(34.25±5.67)次/min、(104.52 ±7.25) mmHg、7.29 ±0.06、(81.52 ±5.01)％、(55.30 ±7.14) mmHg、(46.23±10.30) mmHg和(831.59 ±292.65) ng/L,治疗3h后上述8项指标均有明显改善,心率、呼吸频率、MAP、pH值、SaO2、PaO2、PaCO2和BNP分别为(87.27 ±5.74)次/min(t=32.794,P ＜0.01)、(20.15 ±2.54)次/min(t=12.636,P＜0.01)、(76.57±3.76) mmHg(t=19.055,P＜0.01) 、7.40 ±0.06(t =7.218,P ＜0.01)、(97.16±1.27)％(t=16.848,P ＜0.01)、(92.80 ±6.24)mmHg(t=22.019,P＜0.01)、(40.56±5.19) mmHg(t=2.737,JP＜0.05)和(265.52±65.39) ng/L(t=10.511,P＜0.01).对照组治疗前心率、呼吸频率、MAP、PH值、SaO2、PaO2、PaCO2和BNP分别为(132.13 ±5.31)次/min、(34.96±4.78)次/min、(102.56 ±7.14) mmHg、7.30 ±0.06、(82.15 ±5.24)％、(54.56±6.27) mmHg、(44.30±9.27) mmHg和(823.15±277.26) ng/L,治疗后心率[(92.15 ±4.28)次/min,t=32.638 、P＜0.01]、呼吸频率[(23.91 ±3.27)次/min,t=10.634、P＜0.01]、MAP[(82.83±3.52) mmHg,t =13.800 、P＜0.01]、SaO2[(93.16±2.59)％,t=10.488、P＜0.01)]、PaO2[(75.19±3.52) mmHg,t=15.974、P ＜0.01]和BNP[(371.15±87.55) ng/L,t=8.656 、P＜0.01]比较差异均有统计学意义;pH值、PaCO2较前无明显改变,分别为7.32 ±0.05(t=1.426,P =0.159) 、(43.78 ±6.74)mmHg(t =0.253,P=0.801).治疗组治疗后心率、呼吸频率、MAP、pH值、SaO2、PaO2、PaCO2和BNP较对照组改善更明显,差异均有统计学差异(t值分别为3.795、5.056、6.767、5.703、7.721、13.686、2.107、5.382,P ＜0.01或P＜0.05).结论 应用无创正压通气能迅速改善急性左心衰竭并低氧血症患者心功能,纠正低氧血症,降低血浆BNP水平.
目的 觀察無創正壓通氣治療急性左心衰竭閤併低氧血癥患者的療效.方法 將62例急性左心衰竭閤併低氧血癥患者隨機分為治療組31例和對照組31例,兩組均給予常規內科治療,治療組應用無創正壓通氣治療,分彆鑑測兩組患者治療前、後的血氣分析指標、B型腦鈉肽(BNP)、臨床錶現等變化.結果 治療組臨床癥狀緩解時間[(33.7 ±7.9) min]明顯短于對照組[(55.9±12.1) min],兩組比較差異有統計學意義(t=8.554,P ＜0.01).治療組治療前心率、呼吸頻率、平均動脈壓(MAP)、pH值、血氧飽和度(SaO2)、動脈血氧分壓(PaO2)、動脈血二氧化碳分壓(PaCO2)、B型腦鈉肽(BNP)分彆為(133.89 ±5.45)次/min、(34.25±5.67)次/min、(104.52 ±7.25) mmHg、7.29 ±0.06、(81.52 ±5.01)％、(55.30 ±7.14) mmHg、(46.23±10.30) mmHg和(831.59 ±292.65) ng/L,治療3h後上述8項指標均有明顯改善,心率、呼吸頻率、MAP、pH值、SaO2、PaO2、PaCO2和BNP分彆為(87.27 ±5.74)次/min(t=32.794,P ＜0.01)、(20.15 ±2.54)次/min(t=12.636,P＜0.01)、(76.57±3.76) mmHg(t=19.055,P＜0.01) 、7.40 ±0.06(t =7.218,P ＜0.01)、(97.16±1.27)％(t=16.848,P ＜0.01)、(92.80 ±6.24)mmHg(t=22.019,P＜0.01)、(40.56±5.19) mmHg(t=2.737,JP＜0.05)和(265.52±65.39) ng/L(t=10.511,P＜0.01).對照組治療前心率、呼吸頻率、MAP、PH值、SaO2、PaO2、PaCO2和BNP分彆為(132.13 ±5.31)次/min、(34.96±4.78)次/min、(102.56 ±7.14) mmHg、7.30 ±0.06、(82.15 ±5.24)％、(54.56±6.27) mmHg、(44.30±9.27) mmHg和(823.15±277.26) ng/L,治療後心率[(92.15 ±4.28)次/min,t=32.638 、P＜0.01]、呼吸頻率[(23.91 ±3.27)次/min,t=10.634、P＜0.01]、MAP[(82.83±3.52) mmHg,t =13.800 、P＜0.01]、SaO2[(93.16±2.59)％,t=10.488、P＜0.01)]、PaO2[(75.19±3.52) mmHg,t=15.974、P ＜0.01]和BNP[(371.15±87.55) ng/L,t=8.656 、P＜0.01]比較差異均有統計學意義;pH值、PaCO2較前無明顯改變,分彆為7.32 ±0.05(t=1.426,P =0.159) 、(43.78 ±6.74)mmHg(t =0.253,P=0.801).治療組治療後心率、呼吸頻率、MAP、pH值、SaO2、PaO2、PaCO2和BNP較對照組改善更明顯,差異均有統計學差異(t值分彆為3.795、5.056、6.767、5.703、7.721、13.686、2.107、5.382,P ＜0.01或P＜0.05).結論 應用無創正壓通氣能迅速改善急性左心衰竭併低氧血癥患者心功能,糾正低氧血癥,降低血漿BNP水平.
목적 관찰무창정압통기치료급성좌심쇠갈합병저양혈증환자적료효.방법 장62례급성좌심쇠갈합병저양혈증환자수궤분위치료조31례화대조조31례,량조균급여상규내과치료,치료조응용무창정압통기치료,분별감측량조환자치료전、후적혈기분석지표、B형뇌납태(BNP)、림상표현등변화.결과 치료조림상증상완해시간[(33.7 ±7.9) min]명현단우대조조[(55.9±12.1) min],량조비교차이유통계학의의(t=8.554,P ＜0.01).치료조치료전심솔、호흡빈솔、평균동맥압(MAP)、pH치、혈양포화도(SaO2)、동맥혈양분압(PaO2)、동맥혈이양화탄분압(PaCO2)、B형뇌납태(BNP)분별위(133.89 ±5.45)차/min、(34.25±5.67)차/min、(104.52 ±7.25) mmHg、7.29 ±0.06、(81.52 ±5.01)％、(55.30 ±7.14) mmHg、(46.23±10.30) mmHg화(831.59 ±292.65) ng/L,치료3h후상술8항지표균유명현개선,심솔、호흡빈솔、MAP、pH치、SaO2、PaO2、PaCO2화BNP분별위(87.27 ±5.74)차/min(t=32.794,P ＜0.01)、(20.15 ±2.54)차/min(t=12.636,P＜0.01)、(76.57±3.76) mmHg(t=19.055,P＜0.01) 、7.40 ±0.06(t =7.218,P ＜0.01)、(97.16±1.27)％(t=16.848,P ＜0.01)、(92.80 ±6.24)mmHg(t=22.019,P＜0.01)、(40.56±5.19) mmHg(t=2.737,JP＜0.05)화(265.52±65.39) ng/L(t=10.511,P＜0.01).대조조치료전심솔、호흡빈솔、MAP、PH치、SaO2、PaO2、PaCO2화BNP분별위(132.13 ±5.31)차/min、(34.96±4.78)차/min、(102.56 ±7.14) mmHg、7.30 ±0.06、(82.15 ±5.24)％、(54.56±6.27) mmHg、(44.30±9.27) mmHg화(823.15±277.26) ng/L,치료후심솔[(92.15 ±4.28)차/min,t=32.638 、P＜0.01]、호흡빈솔[(23.91 ±3.27)차/min,t=10.634、P＜0.01]、MAP[(82.83±3.52) mmHg,t =13.800 、P＜0.01]、SaO2[(93.16±2.59)％,t=10.488、P＜0.01)]、PaO2[(75.19±3.52) mmHg,t=15.974、P ＜0.01]화BNP[(371.15±87.55) ng/L,t=8.656 、P＜0.01]비교차이균유통계학의의;pH치、PaCO2교전무명현개변,분별위7.32 ±0.05(t=1.426,P =0.159) 、(43.78 ±6.74)mmHg(t =0.253,P=0.801).치료조치료후심솔、호흡빈솔、MAP、pH치、SaO2、PaO2、PaCO2화BNP교대조조개선경명현,차이균유통계학차이(t치분별위3.795、5.056、6.767、5.703、7.721、13.686、2.107、5.382,P ＜0.01혹P＜0.05).결론 응용무창정압통기능신속개선급성좌심쇠갈병저양혈증환자심공능,규정저양혈증,강저혈장BNP수평.
Objective To investigate the effect of noninvasive positive pressure ventilation treatment on patients with acute left heart failure and hyoxemia.Methods Sixty-two patients with acute left heart failure and hyoxemia were divided into control group (31 cases) and treatment group (31 cases).All patients were treated with a conventional therapy plan and patients in treatment were received noninvasive positive pressure ventilation beside conventional therapy.Blood gas analysis,plasma B-type natriuretic peptide (BNP) and clinical manifestation before and after treatment were monitored.Results The time of clinical manifestation al0leviation in treatment group was (33.7 ±7.9) min,shorter than that of control group ((55.9 ± 12.1) min,t =8.554,P ＜0.01).Compared with pre-treatment,heart rate (HR),respiratory rate(RR),mean arterial pressure(MAP),pH,oxygen saturation of blood (SaO2),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide(PaCO2) and BNP in treatment group were improved significantly(HR:(133.89 ± 5.45) beat/ min vs.(87.27 ± 5.74) beat/min,t =32.794,P ＜ 0.01 ; RR:(34.25 ± 5.67) beat/min vs.(20.15 ± 2.54) beat/min,t =12.636,P ＜ 0.01 ; MAP:(104.52 ± 7.25) mmHg vs.(76.57 ± 3.76) mmHg,t =19.055,P ＜0.01; pH:(7.29±0.06) vs.(7.40 ±0.06),t=7.218,P＜0.01;SaO2:(81.52 ±5.01)％ vs.(97.16±1.27) ％,t =16.848,P ＜ 0.01 ; PaO2:(55.30 ± 7.14) mmHg vs.(92.80 ± 6.24) mmHg,t =22.019,P ＜0.01;PaCO2:(46.23 ±10.30) mmHg vs.(40.56 ±5.19) mmHg,t =2.737,P＜0.05;BNP:(831.59 ±292.65) ng/L vs.(265.52 ±65.39) ng/L,t =10.511,P ＜0.01).And after treatment,HR,RR,MAP,SaO2,PaO2,BNP in control group were improved compared with that before treatment (HR:(132.13 ± 5.31) beat/min vs.(92.15 ± 4.28) beat/min,t =32.638,P ＜ 0.01 ;RR:(34.96 ± 4.78) beat/min vs.(23.91 ± 3.27) beat/min,t=l0.634,P＜0.01;MAP:(102.56 ±7.14) mmHg vs.(82.83±3.52) mmHg,t =13.800,P＜0.01;SaO2:(82.15 ± 5.24) ％ vs.(93.16 ± 2.59) ％,t =10.488,P ＜ 0.01 ; PaO2:(54.56 ± 6.27) mmHg vs.(75.19 ±3.52) mmHg,t =15.974,P ＜0.01 ;BNP:(823.15 ±277.26) ng/L vs.(371.15 ±87.55) ng/L,t =8.656,P ＜0.01).Statistical differences of pH and PaCO2 were not found in the control group before and after treatment(pH:7.32 ± 0.05,t =1.426,P =0.159 ;PaCO2:(43.78 ± 6.74) mmHg,t =0.253,P =0.801).HR,RR,MAP,pH,SaO2,PaO2,PaCO2 and BNP in treatment group were more significantly improved than that of control group(t =3.795,5.056,6.767,5.703,7.721,13.686,2.107 respectively,P ＜ 0.01or P ＜ 0.05).Conclusion The therapy plan of noninvasive positive pressure ventilation on patients with acute left heart failure and hyoxemia can improve cardiac function and oxygenation quickly,and decrease the plasma BNP level.
