应用无创机械通气治疗急性左心衰合并呼吸衰竭的疗效探析

目的探讨采用正压通气对急性左心衰竭合并呼吸衰竭的疗效。方法选择2006年1月～2010年12月广西壮族自治区南宁市第二人民医院治疗的急性左心衰竭合并呼吸衰竭患者80例,分为观察组及对照组,每组各40例。对照组采用常规治疗,观察组在常规治疗的基础上使用无创机械通气治疗。比较两组治疗效果、治疗依从性及动脉血气指标。结果观察组喘息气急症状缓解率95.0%（38/40）]高于对照组70.0%（28/40）],观察组半年复发率0（0）]低于对照组10.0%（4/40）],观察组平均住院时间（5.3±1.0）d]较对照组（8.7±2.1）d]短,差异均有统计学意义（P〈0.05）。观察组治疗期间清楚病情特点和变应原比例95.0%（38/40）]、遵医嘱按时服药比例92.5%（37/40）]、掌握雾化吸入技术比例72.5%（29/40）]均高于对照组45.0%（18/40）、50.0%（20/40）、42.5%（17/40],差异均有统计学意义（均P〈0.05）。观察组和对照组治疗前PaO2（41.7±10.1）、（40.4±9.2）mm Hg]及SaO2（75.9±13.1）%、（76.1±14.6）%]差异无统计学意义（P〉0.05）;观察组治疗后72 h PaO2（90.4±11.3）mm Hg]高于治疗前（41.7±10.1）mm Hg],对照组治疗后72 h PaO2（83.3±10.5）mm Hg]高于治疗前（40.4±9.2）mm Hg],差异有统计学意义（P〈0.05）;观察组治疗后72 h SaO2（98.7±5.1）%]高于治疗前（75.9±13.1）%],对照组治疗后72 hSaO2（90.1±3.4）%]高于治疗前（76.1±14.6）%],差异有统计学意义（P〈0.05）;治疗后72 h观察组PaO2（90.4±11.3）mm Hg]及SaO2（98.7±5.1）%]均高于对照组（83.3±10.5）mm Hg、（90.1±3.4）%],差异有统计学意义（P〈0.05）。结论无创机械通气治疗急性左心衰竭合并呼吸衰竭取得较好疗效,值得临床推广。

Curative effect analysis of application of noninvasive mechanical ventilation in the treatment of acute left heart failure combined with respiratory failure

Objective To explore the curative effect of positive pressure ventilation treatment of acute left ventricular failure combined with respiratory failure.Methods 80 patients of acute left ventricular failure combined with respiratory failure from January 2006 to December 2010 in the Second People＇s Hospital in Nanning City were selected and divided into observation group and control group with 40 cases in each group.Patients in control group were treated with conventional therapy,patients in observation group were treated with noninvasive mechanical ventilation based on the conventional therapy.Therapeutic effect,treatment compliance and indexes of arterial blood gases were compared. Results Breathing air emergency symptoms remission rate in observation group 95.0%（38/40）] was higher than that in control group 70.0%（28/40）],recurrence rate in half a year in observation group was lower than that in control group 10.0%（4/40）],average stay in hospital in observation group （5.3 ±1.0） d] were shorter than those in control group （8.7±2.1） d],the differences were all statistically significant（P 0.05）.The rate of understanding of characteristics and allergen during treatment,taking medicine on time,master atomization inhalation technology in observation group 95.0%（38/40）,92.5%（37/40）,72.5%（29/40）] were all higher than those in control group 45.0%（18/40）, 50.0%（20/40）,42.5%（17/40）],the differences were all statistically significant（P 0.05）.The differences of PaO 2 and SaO 2 before treatment in the two groups （41.7 ±10.1） vs（40.4±9.2） mmHg,（75.9±13.1） vs（76.1±14.6）%] were all not statistically significant（P 0.05）;PaO 2 in observation group 72 h after the treatment （90.4±11.3） mm Hg] were higher than those before the treatment （41.7 ±10.1） mm Hg],PaO 2 in control group 72 h after the treatment （83.3 ±10.5） mm Hg] were higher than those before the treatment （40.4 ±9.2） mm Hg],the differences were all statistically significant（P 0.05）;SaO 2 in observation group 72 h after the treatment （98.7 ±5.1）%] were higher than those before the treatment （75.9±13.1）%],SaO 2 in control group 72 h after the treatment （90.1 ±3.4）%] were higher than those before the treatment （76.1±14.6）%],the differences were all statistically significant（P 0.05）;PaO 2 in observation group 72 h after the treatment （90.4 ±11.3） mm Hg] and SaO 2 in observation group （98.7 ±5.1）%] were all higher than those in control group （83.3±10.5） mm Hg,（90.1±3.4）%],the differences were all statistically significant（P 0.05）.Conclusion Noninvasive mechanical ventilation in the treatment of patients with acute left ventricular failure combined with respiratory failure has made a good effect,it is worthy of clinical application.