天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (10): 1058-1062.doi: 10.11958/20191087

• 临床研究 • 上一篇    下一篇

极早期应用无创呼吸机治疗急性心力衰竭患者的疗效分析

任凯，陈树涛，冯津萍，耿婕△   

  1. 天津市胸科医院心内科（邮编300222）
  • 收稿日期:2019-04-10 修回日期:2019-06-30 出版日期:2019-10-15 发布日期:2019-11-11
  • 通讯作者: 耿婕 E-mail:gengjie_1973@126.com
  • 基金资助:
    慢性心力衰竭患者炎症因子水平及抗炎干预的研究

Analysis of the efficacy of extremely early application of noninvasive ventilator in patients with acute heart failure

REN Kai, CHEN Shu-tao, FENG Jin-ping, GENG Jie△   

  1. Department of Cardiology, Tianjin Chest Hospital, Tianjin 300222, China
  • Received:2019-04-10 Revised:2019-06-30 Published:2019-10-15 Online:2019-11-11
  • Supported by:
     

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摘要： 摘要：目的 探讨极早期（发病10～30 min）应用无创呼吸机治疗急性心力衰竭患者的临床疗效。方法 回顾我 院心脏重症病区于2017年1月—2018年12月间收治的心力衰竭患者且其住院期间出现急性心力衰竭发作的100 例，按照无创呼吸机使用时机分为极早应用组44例（10～30 min应用）和对照组56例（30 min～24 h应用），2组患者 在出现急性心力衰竭发作后均给予鼻导管吸氧、减轻心脏负荷、控制心率、维持血压、改善心肌代谢等药物治疗，在 此基础上极早应用组在10～30 min内立即给予无创呼吸机辅助通气治疗，对照组于发病后30 min～24 h才给予无创 呼吸机辅助通气治疗。2组治疗前性别、临床症状、生命体征等比较差异无统计学意义（均P＞0.05）。监测治疗前后 24 h 患者的呼吸频率（RR）、静息心率（HR）、平均动脉压（MAP）、动脉血氧分压［p（O2）］、动脉血二氧化碳分 压［p（CO2）］、乳酸（Lac）及治疗1周后血清N端B型脑钠肽前体（NT-proBNP）水平，同时比较2组治疗的总有效率。 结果 2组患者在治疗前的相关指标比较差异无统计学意义，治疗后24 h极早应用组的RR、HR、MAP、p（O2）较对照 组明显改善（均 P＜0.05），p（CO2）、Lac 及 NT-proBNP 较对照组明显降低（均 P＜0.05）。极早应用组的总有效率为 90.91%，对照组总有效率为82.14%，2组比较差异无统计学意义（P＞0.05）。结论 极早期（发病10～30 min）应用无 创呼吸机辅助治疗对急性心力衰竭发作患者有更显著的治疗效果。

关键词: 心力衰竭, 无创通气, 利钠肽, 脑, 平均动脉压

Abstract: Abstract: Objective To analyze extremely early application of noninvasive ventilator in patients with acute heart failure. Methods A total of 100 patients with acute heart failure who were admitted and treated in Cardiac Intensive Care Unit (CICU) from January 2017 to December 2018 were studied retrospectively. Patients were divided into the extremely early application group (n=44) and the control group (n=56). Patients of two groups were given nasal tube oxygenation to reduce cardiac load, control heart rate and blood pressure, and improve myocardial metabolism after the onset of acute heart failure. On the basis of routine treatment, the application group was given extremely early application (10-30 min) of noninvasive ventilator assisted ventilation, and the control group was given noninvasive ventilator assisted ventilation in 30 min -24 h after onset. There were no significant differences in gender, clinical symptoms and vital signs before treatment between the two groups (P＞0.05). Data of respiratory rate (RR), resting heart rate (HR), mean arterial pressure (MAP), arterial blood oxygen partial pressure [p(O2)], arterial blood carbon dioxide partial pressure [p(CO2)] and lactic acid (Lac) were monitored before and 24 h after treatment. The serum levels of N-terminal B-brain natriuretic peptide (NT-proBNP) were also recorded before and after 1 week of treatment. The total efficacy rate was compared between the two groups. Results There were no significant differences in the related indicators before treatment between two groups of patients. The RR, HR, MAP and p(O2) were significantly improved after 24 h-treatment in the extremely early application group than those of control group (P＜0.05). Values of p(CO)2, Lac and NT-proBNP were significantly decreased in the extremely early application group than those of the control group (P＜0.05). The total efficacy rates were 90.91% in the early application group and 82.14% in the control group. There was no significant difference between the two groups (P＞0.05). Conclusion The extremely early application (10-30 min) of noninvasive ventilator assisted therapy has significant effect on patients with acute heart failure.

Key words: heart failure, noninvasive ventilation, natriuretic peptide, brain, mean arterial blood pressure

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