中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
18期
1419-1421
,共3页
叶明%贾平%王旭%米玉红
葉明%賈平%王旭%米玉紅
협명%가평%왕욱%미옥홍
通气机,机械%尿毒症%心力衰竭%治疗结果
通氣機,機械%尿毒癥%心力衰竭%治療結果
통기궤,궤계%뇨독증%심력쇠갈%치료결과
Ventilators,mechanical%Uremia%Heart failure%Treatment outcome
目的 观察BiPAP呼吸机辅助通气对尿毒症患者急性左心衰发作的疗效.方法 对2008年2月至2012年10月在北京安贞医院急诊危重症中心已接受透析治疗且发作急性左心衰,常规予以扩血管、强心、持续肾替代治疗(CRRT) 30 min后无缓解的50例尿毒症患者立即予以BiPAP呼吸机辅助通气.观察入院常规治疗30 min末、BiPAP呼吸机辅助通气1、2h后收缩压、舒张压、心率、呼吸频率、动脉血氧分压(PaO2)及二氧化碳分压(PaCO2)等指标的变化,以及BiPAP呼吸机辅助通气2h后血浆脑利钠肽(BNP)水平、左室射血分数(LVEF)和临床表现的变化.结果 经BiPAP呼吸机辅助通气后,患者临床症状均明显好转.与入院后常规治疗30 min末比较,辅助通气1、2h后收缩压[(160±17)、(147±18)比(172±20) mmHg](1 mmHg =0.133 kPa)、舒张压[(90±9)、(85±10)比(98±10) mmHg)]、心率[(95±8)、(88±9)比(102±12)次/min)]、呼吸频率[(20±3)、(17±4)比(26±3)次/min]均显著降低,PaO2显著升高[(87±9)、(94±12)比(81±9) mmHg](均P＜0.05);辅助通气2h后血浆BNP水平显著降低[(1 084±398)比(2 686 ±576) μg/L)],LVEF显著升高[(52％±7％)比(39％±9％)](均P＜0.01).结论 早期应用BiPAP呼吸机辅助通气能有效缓解尿毒症患者急性左心衰发作的临床症状,改善心功能,安全有效.
目的 觀察BiPAP呼吸機輔助通氣對尿毒癥患者急性左心衰髮作的療效.方法 對2008年2月至2012年10月在北京安貞醫院急診危重癥中心已接受透析治療且髮作急性左心衰,常規予以擴血管、彊心、持續腎替代治療(CRRT) 30 min後無緩解的50例尿毒癥患者立即予以BiPAP呼吸機輔助通氣.觀察入院常規治療30 min末、BiPAP呼吸機輔助通氣1、2h後收縮壓、舒張壓、心率、呼吸頻率、動脈血氧分壓(PaO2)及二氧化碳分壓(PaCO2)等指標的變化,以及BiPAP呼吸機輔助通氣2h後血漿腦利鈉肽(BNP)水平、左室射血分數(LVEF)和臨床錶現的變化.結果 經BiPAP呼吸機輔助通氣後,患者臨床癥狀均明顯好轉.與入院後常規治療30 min末比較,輔助通氣1、2h後收縮壓[(160±17)、(147±18)比(172±20) mmHg](1 mmHg =0.133 kPa)、舒張壓[(90±9)、(85±10)比(98±10) mmHg)]、心率[(95±8)、(88±9)比(102±12)次/min)]、呼吸頻率[(20±3)、(17±4)比(26±3)次/min]均顯著降低,PaO2顯著升高[(87±9)、(94±12)比(81±9) mmHg](均P＜0.05);輔助通氣2h後血漿BNP水平顯著降低[(1 084±398)比(2 686 ±576) μg/L)],LVEF顯著升高[(52％±7％)比(39％±9％)](均P＜0.01).結論 早期應用BiPAP呼吸機輔助通氣能有效緩解尿毒癥患者急性左心衰髮作的臨床癥狀,改善心功能,安全有效.
목적 관찰BiPAP호흡궤보조통기대뇨독증환자급성좌심쇠발작적료효.방법 대2008년2월지2012년10월재북경안정의원급진위중증중심이접수투석치료차발작급성좌심쇠,상규여이확혈관、강심、지속신체대치료(CRRT) 30 min후무완해적50례뇨독증환자립즉여이BiPAP호흡궤보조통기.관찰입원상규치료30 min말、BiPAP호흡궤보조통기1、2h후수축압、서장압、심솔、호흡빈솔、동맥혈양분압(PaO2)급이양화탄분압(PaCO2)등지표적변화,이급BiPAP호흡궤보조통기2h후혈장뇌리납태(BNP)수평、좌실사혈분수(LVEF)화림상표현적변화.결과 경BiPAP호흡궤보조통기후,환자림상증상균명현호전.여입원후상규치료30 min말비교,보조통기1、2h후수축압[(160±17)、(147±18)비(172±20) mmHg](1 mmHg =0.133 kPa)、서장압[(90±9)、(85±10)비(98±10) mmHg)]、심솔[(95±8)、(88±9)비(102±12)차/min)]、호흡빈솔[(20±3)、(17±4)비(26±3)차/min]균현저강저,PaO2현저승고[(87±9)、(94±12)비(81±9) mmHg](균P＜0.05);보조통기2h후혈장BNP수평현저강저[(1 084±398)비(2 686 ±576) μg/L)],LVEF현저승고[(52％±7％)비(39％±9％)](균P＜0.01).결론 조기응용BiPAP호흡궤보조통기능유효완해뇨독증환자급성좌심쇠발작적림상증상,개선심공능,안전유효.
Objective To explore the clinical efficacies of bilevel positive airway pressure (BiPAP) ventilation in uremic patients with acute heart failure.Methods Fifty uremic patients with acute heart failure on dialysis were recruited from February 2008 to October 2012 at our center.All of them received angiectasis,heart strengthening and continuous renal replacement therapy (CRRT),but their clinical symptoms had no relief 30 min later.Non-invasive ventilation was administered immediately.And the parametric changes of systolic pressure (SBP),diastolic pressure (DBP),heart rate (HR),breathing rate (R),partial pressure of oxygen (PaO2) and carbon dioxide (PaCO2) were observed at 30 min after conventional therapy and 1,2 h later after non-invasive ventilation.And the levels of blood brain natriuretic peptide (BNP),left ventricular ejection fraction (LVEF) and clinical manifestations were observed at 2 h after non-invasive ventilation.Results Their clinical symptoms improved after BiPAP ventilation.And SBP,DBP,P,R and BNP showed a declining tendency,but PaO2 and LVEF showed a rising trend.Compared to conventional therapy,SBP ((160 ± 17),(147 ± 18) vs (172 ± 20) mmHg) (1 mmHg =0.133 kPa),DBP ((90 ±9),(85 ± 10) vs (98 ± 10) mmHg),HR ((95 ±8),(88 ±9) vs (102 ± 12)times/min),R ((20 ±3),(17 ±4) vs (26 ±3) times/min) declined while PaO2((87 ±9),(94 ± 12)vs (81 ± 9) mmHg) increased significantly,1,2 h later after noninvasive ventilator treatment (all P ＜ 0.05); the blood level of BNP decreased ((1084 ± 398) vs (2686 ± 576) μg/L),LVEF elevated (52％ ± 7％ vs 39％ ± 9％) significantly,2 h later after noninvasive ventilator treatment (both P ＜ 0.01).Conclusion As a safe and effective intervention,early use of BiPAP ventilator-assisted breathing in uremic patients with acute heart failure effectively ameliorates their clinical manifestations and improve heart function.
