巩玉刚

[摘要] 目的 觀察无创正压通气应用于重度急性左心衰合并Ⅱ型呼吸衰竭抢救治疗中的疗效。 方法 本次研究对象为我院2015年5月～2016年5月收治的重度急性左心衰合并Ⅱ型呼吸衰竭患者共60例，全部患者根据治疗方法随机分为观察组和对照组，每组各30例，两组患者均予镇静、强心、利尿、扩血管等对症治疗，并进行心电监测，持续动脉血气分析，同时对照组采取鼻导管高流量供氧，观察组采取BiPAP Vision 呼吸机进行无创正压通气治疗，对两组患者治疗前后动脉血气分析指标变化情况、两组患者治疗前后心功能指标LVEF、SV变化情况应用统计学方法进行比较分析。 结果 观察组治疗后的PaO2、PaCO2、pH较对照组变化更显著，其中观察组治疗后的PaO2、pH明显高于对照组，而PaCO2明显低于对照组（P<0.05）。观察组治疗后的心功能指标LVEF、SV较对照组变化更显著，其中观察组治疗后的心功能指标LVEF、SV明显高于对照组（P<0.05）。 结论 重度急性左心衰合并Ⅱ型呼吸衰竭抢救治疗中应用无创正压通气可以提高临床疗效，改善心肺功能，值得推广和应用。

[关键词] 重度急性左心衰合并Ⅱ型呼吸衰竭；呼吸机；动脉血气分析；LVEF

[中图分类号] R541.6；R563.8 [文献标识码] B [文章编号] 1673-9701（2017）12-0116-03

[Abstract] Objective To observe the efficacy of noninvasive positive pressure ventilation in the treatment of severe acute left heart failure complicated with type II respiratory failure. Methods 60 patients with severe acute left heart failure complicated with type II respiratory failure in our hospital from May 2015 to May 2016 60 cases were randomly divided into observation group and control group according to the different treatment methods， 30 cases in each group， two groups of patients were treated with sedative， strong heart diuretic， vasodilator， symptomatic treatment， and continuous ECG monitoring， arterial blood gas， while the control group was treated by nasal catheter with high flow oxygen， the observation group adopted BiPAP Vision ventilation to noninvasive positive pressure ventilation treatment，the arterial blood gas analysis before and after the change， the heart function index of the two groups of patients the indexes of LVEF， SV changes were analyzed by statistical methods between two groups before and after treatment. Results After treatment，the PaO2， PaCO2， pH in the observation group compared with the control group had significant changes， the PaO2， pH in observation group after treatment was significantly higher than the control group， and PaCO2 in observation group was significantly lower than control group，the difference was statistically significant（P<0.05）. The heart function indexes of LVEF， SV in observation group after treatment compared with the control group had significant changes， the observation were significantly higher than the control group，the difference was significant（P<0.05）. Conclusion The application of noninvasive positive pressure ventilation in the treatment of severe acute left heart failure complicated with type II respiratory failure can improve the clinical efficacy and improve the cardiopulmonary function， which is worthy of popularization and application.

[Key words] Severe acute left heart failure complicated with type II respiratory failure； Ventilator； Arterial blood gas analysis； LVEF

急性重度左心衰是急诊科的危重症，主要临床症状为左心室功能及结构出现严重障碍而导致的左心室充盈不足、射血减少，不能满足机体的正常需求的临床综合征，常伴Ⅱ型呼吸衰竭，具有病情急、症状重、病死率高等特点[1]。目前，无创正压通气治疗被证实有利于改善患者肺脏的通气和换气功能，随着无创通气技术的不断发展，其在心血管领域中的应用受到广泛重视[2]。且研究发现，在抢救过程中采用无创正压通气治疗，对于改善心肺功能、防止外周脏器和多脏器功能衰竭具有重要作用[3]。……