陶丽

[摘要] 目的 探討无创正压通气在急性左心衰中的应用效果。 方法 选取2015年1月～2016年6月于重庆涪陵中心医院住院治疗的72例急性左心衰患者为研究对象，根据治疗方法的不同将其分为研究组和对照组，每组各36例。两组患者均给予吸氧、镇静、强心、利尿、扩张血管等对症治疗，研究组在此治疗的基础上给予无创正压通气。观察两组患者治疗前、治疗后2 h、治疗后24 h的血浆N末端脑钠肽前体（NT-proBNP）、超敏C反应蛋白（hs-CRP）的含量，以及呼吸频率（RR）、心率（HR）、平均动脉压（MAP）和动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、动脉血氧饱和度（SaO2）等血气分析指标。 结果 治疗后2、24 h，两组患者NT-proBNP、hs-CRP均较治疗前显著降低，且治疗后24 h低于治疗后2 h，差异均有统计学意义（P < 0.05或P < 0.01）。治疗后2、24 h，研究组NT-proBNP水平均显著低于对照组，治疗后2 h研究组hs-CRP低于对照组，差异均有统计学意义（均P < 0.05）。治疗后2、24 h，两组患者RR、HR、MAP、PaCO2均较治疗前明显降低，PaO2和SaO2较治疗前明显升高，差异均有统计学意义（均P < 0.05）；治疗后2、24 h，研究组PaO2均高于对照组，治疗后24 h PaCO2低于对照组，差异均有统计学意义（均P < 0.05）。研究组总有效率显著高于对照组，差异有统计学意义（P < 0.05）。 结论 无创正压通气可迅速缓解急性左心衰患者的临床症状，提高治疗效果，值得临床推广应用。

[关键词] 急性左心衰；无创正压通气；血气分析；疗效

[中图分类号] R541.61 [文献标识码] A [文章编号] 1673-7210（2016）11（b）-0121-04

[Abstract] Objective To study the application effect of noninvasive positive pressure ventilation for the acute left heart failure. Methods Seventy-two patients with breast cancer in Chongqing Fuling Central Hospital from January 2015 to June 2016 were selected as the study objects， they were divided into research group and the control group according to the different treatments， with 36 cases in each group. Patients of the two groups were given symptomatic treatment， such as oxygen inhalation， sedative， strong heart， diuresis， dilate blood vessels. The patients of the research group were given the treatment of noninvasive positive pressure ventilation in addition. Precursor plasma N-terminal brain natriuretic peptide （NT-proBNP）， hypersensitive C-reactive protein （hs-CRP）， respiratory rate （RR）， heart rate （HR）， mean arterial pressure （MAP） and blood gas analysis， such as arterial partial pressure of oxygen （PaO2）， arterial partial pressure of carbon dioxide （PaCO2）， arterial oxygen saturation （SaO2） and so on， in the two groups before treatment and 2， 24 hours after treatment were observed. Results After treatment for 2， 24 hours， the levels of NT-proBNP and hs-CRP in the two groups were all significantly reduced compared with those before treatment， and those after treatment for 24 hours were lower than those after treatment for 2 hours， the differences were all statistically significant （P < 0.05 or P < 0.01）. After treatment for 2， 24 hours， the levels of NT-proBNP in the research group were all significantly lower than those of control group， 2 hours after treatment， the level of hs-CRP in the research group was lower than that of control group， the differences were all statistically significant （all P < 0.05）. After treatment for 2， 24 hours， RR， HR， MAP， PaCO2 in the two groups were significantly lower than those before treatment， PaO2 and SaO2 were obviously higher than those before treatment， the differences were all statistically significant （all P < 0.05）； 2， 24 hours after treatment， PaO2 of research group was higher than that of control group， 24 hours after treatment， PaCO2 of research group was lower than that of control group， the differences were statistically significant （P < 0.05）. The total effective rate of research group was significantly higher than that of control group， the difference was statistically significant （P < 0.05）. Conclusion Noninvasive positive pressure ventilation can rapidly alleviate the clinical symptoms of patients with acute left heart failure， improve the curative effect， which is worthy of clinical popularization and application.

[Key words] Acute left heart failure； Noninvasive positive pressure ventilation； Blood gas analysis； Curative effect

急性心力衰竭（acute heart failure）是指急性发作或加重的左心功能异常所致的心肌收缩力降低、心脏负荷加重，造成急性心排血量骤降、肺循环压力升高、周围循环阻力增加，引起肺循环充血而出现急性肺瘀血、肺水肿并可伴组织、器官灌注不足和心源性休克的临床综合征，是临床常见的急危重症。随着我国老年人口的逐渐增多，急性重症心力衰竭的发病率也逐年增高。临床上常以面罩或鼻导管吸氧、利尿、扩容、强心等治疗方式改善患者的缺氧症状，但效果并不显著[1-2]。无创正压通气治疗是在自主呼吸的吸气相和呼气相施加不同压力干预的通气方式，吸气时增加患者的肺通气量，呼气时减少患者的残气量，提高肺氧合能力[3-4]。……