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目的:观察乌司他丁联合无创通气治疗难治性左心功能衰竭的效果与安全性。方法:将2010年8月至2013年8月佛山市第二人民医院收治的84例基础心脏病为冠心病的难治性左心功能衰竭的患者随机分为观察组(40例)和对照组(44例),均使用无创通气,观察组联合应用乌司他丁,对照组则仅予常规治疗,比较两组的脑型钠尿肽(BNP)变化、左室射血分数(LVEF)变化、血气分析结果,使用无创通气时间、是否改用气管插管、重症科住院时间等。结果:观察组24、72 h BNP的下降百分比明显高于对照组(P<0.05),观察组与对照组24 h氧分压(Pa O2)、二氧化碳分压(Pa CO2)比较,差异有统计学意义(P<0.05)。观察组7 d左室射血分数(LVEF)高于对照组(P<0.05)。观察组使用无创通气时间、重症科住院时间明显短于对照组(P<0.05)。观察组改用气管插管机械通气率、住院死亡率低于对照组,但差异无统计学意义(P>0.05)。结论:难治性左心功能衰竭患者联合使用乌司他丁与无创通气有利于心功能的恢复,能改善氧合、二氧化碳排出、左室收缩功能,缩短重症科住院治疗,但未证实是否降低住院死亡率。
Objective: To observe the efficacy and safety of ulinastatin combined with noninvasive ventilation in the treatment of refractory left heart failure. Methods: From August 2010 to August 2013, 84 cases of patients with refractory heart failure with underlying heart disease admitted to Second People’s Hospital of Foshan City were randomly divided into observation group (40 cases) and control group (N = 44). Noninvasive ventilation was used in the observation group and ulinastatin combined with the observation group. The control group was treated only routinely. The changes of BNP and LVEF were compared between the two groups , Blood gas analysis results, the use of non-invasive ventilation time, whether to switch to endotracheal intubation, intensive care hospital time. Results: The percentage of decrease of BNP in observation group was significantly higher than that in control group at 24 and 72 h (P <0.05). There was statistical difference between PaO2 and Pa CO2 in observation group and control group Significance (P <0.05). The left ventricular ejection fraction (LVEF) in observation group at 7 d was higher than that in control group (P <0.05). The non-invasive ventilation time in the observation group was shorter than that in the control group (P <0.05). The observation group switched to intubation mechanical ventilation rate, hospital mortality was lower than the control group, but the difference was not statistically significant (P> 0.05). Conclusion: The combination of ulinastatin and noninvasive ventilation in refractory patients with left heart failure is beneficial to the recovery of cardiac function, and can improve oxygenation, carbon dioxide emission, left ventricular systolic function and shorten the hospitalization of intensive care, but it has not been confirmed whether reduced In-hospital mortality.