阳小进　汪宇

[关键词] 有创机械通气;无创机械通气;重症;急性左心衰

[中图分类号] R541.6          [文献标识码] B          [文章编号] 1673-9701（2021）17-0091-04

Analysis on the value and feasibility of mechanical ventilation in the treatment of severe acute left heart failure

YANG Xiaojin   WANG Yu

Department of Emergency， the Second Affiliated Hospital of Nanhua University， Hengyang   421001， China

[Abstract] Objective To explore the value and feasibility of mechanical ventilation in the treatment of severe acute left heart failure. Methods A total of 200 patients with severe acute left heart failure in the Department of Emergency in the Second Affiliated Hospital of University of South China from May 2018 to October 2019 were selected， and they were divided into the observation group（n=100） and the control group（n=100） according to the random number table method. The observation group was treated with invasive mechanical ventilation， while the control group was treated with non-invasive mechanical ventilation.RR，HR，blood gas analysis indices， therapeutic efficacy， MAP and pH indices of the two groups in different time periods were compared. Results There were no statistically significant differences in PaO2， RR， HR and SaO2 indices between the two groups after 0 hour of treatment （P>0.05）. The levels of PaO2 and SaO2 in the observation group were higher than those in the control group after 0.5 hour，1 hour and 3 hours of treatment， and the levels of RR and HR were all lower than those in the control group， with statistically significant differences（P<0.05）. The total effective rate of the observation group was 96.00%， which was significantly higher than 75.00% of the control group， with statistically significant difference（P<0.05）. MAP （74.12±1.81） mmHg and pH （7.38±1.06） in the observation group were both higher than those in the control group after 3 hours of treatment， with statistically significant differences（P<0.05）. Conclusion Through the implementation of invasive mechanical ventilation in patients with severe acute left heart failure， remarkable therapeutic efficacy has been achieved. Meanwhile， the prognosis of patients has been improved.

[Key words] Invasive mechanical ventilation; Non-invasive mechanical ventilation; Severe illness; Acute left heart failure

重癥急性左心衰发病率不断增加，是临床常见综合征，该疾病主要是由于人体心排出量急剧下降、心脏前后负荷所致，也是临床常见的急危重症，一般是由肺循环充血所引起，从而使患者肺静脉压增高、左心室舒张末压增加，由于肺间质水肿而导致低氧血症，若患者缺氧症状未及时得到改善，容易导致不良后果，因此在对重症急性左心衰患者实施抢救的过程中，应对每位患者的缺氧状态有效改善[1]。一般对于重症ALVF（急性左心衰）患者实施机械通气方式，从而改善缺氧状态，机械通气方法具有多种，例如无创机械通气、有创机械通气，研究显示，有创机械通气创伤大、同时并发症多，但对于病情危重、伴有呼吸衰竭的患者来说，效果较好，而临床对于机械通气方法、有创机械通气治疗时机仍存在争议[2]。因此，本研究对机械通气在重症急性左心衰治疗中的价值及可行性分析进行研究，现报道如下。

1 资料与方法

1.1 一般资料

选取2018年5月至2019年10月在本院就诊的重症急性左心衰患者200例，采用随机分组法，分为观察组与对照组，每组各100例。纳入标准：①依据第7版诊断学的诊断标准进行评定[3]，患者心功能分级Ⅲ级以上，且各项临床资料完整;②患者和家属均在知情同意的原则下完成研究。排除标准：①排除昏迷、严重心律失常患者;②排除存在脑血管意外和外伤患者;③排除存在肺部肿瘤疾病者[4]。