2018 年第 2 期 第 13 卷

药物联合无创机械通气治疗顽固性心力衰竭的效果

作者：王瑞哲

英文作者：

单位：712000陕西省咸阳市，陕西中医药大学附属医院重症医学科

英文单位：

关键词：顽固性心力衰竭；药物治疗；无创机械通气

英文关键词：

• 摘要：

• 目的    探讨药物联合无创机械通气治疗顽固性心力衰竭的效果。方法    选取2013年2月至2015年12月陕西中医药大学附属医院收治的顽固性心力衰竭患者124例进行前瞻性研究。根据其入院单双日随机分为对照组和观察组，各62例。对照组采用有创机械通气治疗，观察组采用药物联合无创机械通气治疗。比较2组患者通气前和通气3、24 h后血气指标［动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）、呼吸频率、心率］、血流动力学指标［血管外肺水指数（EVLWI）、全心舒张末期容积指数（GEDVI）、胸腔内血容积指数（ITBVI）、心脏功能指数（CFI）］、实验室检测指标［B型脑钠肽（BNP）、心肌肌钙蛋白T（cTnT）、血乳酸］和临床疗效。结果    通气前2组间各项指标比较，差异均无统计学意义（均P＞0.05）。通气3 h后，观察组PaO2、GEDVI均高于对照组［（60±4）mmHg（1 mmHg=0.133 kPa）比（58±4）mmHg、（821±23）ml/m2比（790±26）ml/m2］，呼吸频率、心率、CFI、BNP、血乳酸均低于对照组［（26.5±2.1）次/min比（28.2±2.4）次/min、（110±3）次/min比（110±5）次/min、（4.0±1.4）L/min比（4.5±1.2）L/min、（1 573±177）pmol/L比（2 033±157）pmol/L、（3.7±1.9）mmol/L比（4.7±1.6）mmol/L］，差异均有统计学意义（均P＜0.05）。通气24 h后，观察组PaO2、PaCO2、SaO2、EVLWI、GEDVI、ITBVI均高于对照组，呼吸频率、心率、CFI、BNP、cTnT、血乳酸均低于对照组，差异均有统计学意义（均P＜0.05）。观察组患者临床总有效率明显高于对照组［95.2%(59/62)比74.2%(46/62)］，差异有统计学意义（χ2=10.695，P=0.013）。结论    药物联合无创机械通气治疗顽固性心力衰竭，能明显改善患者的呼吸和通气功能，临床疗效优于有创机械通气治疗。

• Effect of drug combined with noninvasive mechanical ventilation on refractory heart failure

  Wang Ruizhe

  Intensive Care Unit, Affiliated Hospital of Shaanxi University of Chinese Medicine, Shaanxi Province, Xianyang 712000, China, Email: wangru1zhe@126.com

  【Abstract】Objective    To investigate the effect of drug combined with noninvasive mechanical ventilation on refractory heart failure. Methods    From February 2013 to December 2015, 124 cases of intractable heart failure were enrolled in Affiliated Hospital of Shaanxi University of Chinese Medicine, and they were randomly divided into control group and observation group, with 62 cases in each group. The control group was treated by invasive mechanical ventilation, and the observation group was treated by drugs combined with noninvasive mechanical ventilation. Blood gas indexes［arterial partial pressure of oxygen(PaO2), arterial partial pressure of carbon dioxide(PaCO2), arterial oxygen saturation(SaO2), respiratory rate, heart rate］, hemodynamic indexes［extravascular lung water index(EVLWI), global end-diastolic volume index(GEDVI), intrathoracic blood volume index(ITBVI), cardiac function index(CFI)］, laboratory indexes［B-type brain natriuretic peptide(BNP), cardiac troponin T(cTnT), lactic acid］ and the clinical curative effect were analyzed. Results    There were no significant differences of blood gas, hemodynamic and laboratory indexes between groups before ventilation(P＞0.05). After 3 h ventilation, PaO2 and GEDVI in observation group were significantly higher than those in control group［（60±4）mmHg vs （58±4）mmHg, （821±23）ml/m2 vs （790±26）ml/m2］; respiratory rate, heart rate, CFI, BNP and lactic acid in observation group were significantly lower than those in control group［（26.5±2.1）times/min vs （28.2±2.4）times/min, （110±3）times/min vs （110±5）times/min, （4.0±1.4）L/min vs （4.5±1.2）L/min, （1 573±177）pmol/L vs （2 033±157）pmol/L, （3.7±1.9）mmol/L vs （4.7±1.6）mmol/L］(all P＜0.01). After 24 h ventilation, PaO2, PaCO2, SaO2, EVLWI, GEDVI and ITBVI in observation group were significantly higher than those in control group; respiratory rate, heart rate, CFI, BNP, cTnT and lactic acid in observation group were significantly lower than those in control group(all P＜0.05). The total effective rate in observation group was significantly higher than that in control group［95.2%(59/62) vs 74.2%(46/62)］（χ2=10.695, P=0.013）. Conclusion    Drug combined with noninvasive mechanical ventilation treating refractory heart failure can significantly improve breathing and ventilation function.

  【Key words】Refractory heart failure；Drug therapy；Noninvasive mechanical ventilation