论文部分内容阅读
目的:探讨无创双水平正压通气(BiPAP)治疗慢性心肺功能衰竭急性发作致高乳酸血症患者的临床疗效。方法:回顾性分析60例慢性心肺功能衰竭急性发作致高乳酸血症患者的临床资料,根据治疗方案分为常规氧疗组30例(常规组)和BiPAP无创组30例(BiPAP组)。观察入科首日及第3天基本生命体征及临床试验指标,包括血乳酸、pH、pO2、pCO2、NT-proBNP、白细胞总数、肌酐及白蛋白;研究观察截点为5d内的插管率。结果:2组比较,BiPAP组ICU住院时间更短[(10.5±2.4)d vs.(6.3±2.6)d,t=6.5,P<0.05],5d内插管率更低(36.6%vs.13.3%,t=4.35,P<0.05);可观察到BiPAP组的乳酸明显下降[(1.8±0.4)mmHg vs.(1.2±0.5)mmHg(1mmHg=0.133kPa),P<0.05],最终第3天乳酸值低于常规组[(1.5±0.4)mmol/L vs.(2.3±0.4)mmol/L,P<0.05],同步变化的还有:NT-proBNP的降低程度[(200±21)ng/L vs.(104±21)ng/L]及第3天数值[(216±100)ng/L vs.(354±115)ng/L,P<0.05];pO2、pCO2的3d差值低于常规组[(13±7)mmHg vs.(24±15)mmHg];(18±7)mmHg vs.(26±6)mmHg;P<0.05)。结论:BiPAP能同步治疗慢性肺疾病合并心力衰竭患者的缺氧血症及降低心脏负荷,进而纠正组织缺氧及酸中毒。
Objective: To investigate the clinical efficacy of noninvasive bi-level positive pressure ventilation (BiPAP) in patients with acute lactic acidosis caused by chronic heart failure. Methods: A retrospective analysis of 60 cases of chronic heart failure patients with acute lactic acidosis clinical data, divided into conventional oxygen therapy group 30 cases (conventional group) and BiPAP noninvasive group of 30 patients (BiPAP group). The basic vital signs and clinical trial indexes, including blood lactic acid, pH, pO2, pCO2, NT-proBNP, total white blood cells, creatinine and albumin, were observed on the first day and the third day of admission. . Results: Compared with the control group, the length of stay in ICU of BiPAP group was shorter than that of control group (P <0.05). The ICU of BiPAP group was shorter than that of ICU group (10.5 ± 2.4 vs. 6.3 ± 2.6 days, t = 6.5, P <0.05) 13.3%, t = 4.35, P <0.05). Lactic acid was significantly decreased in BiPAP group [(1.8 ± 0.4) mmHg vs. (1.2 ± 0.5) mmHg (1mmHg = 0.133 kPa), P < (P <0.05). The level of lactate in 3 days was lower than that in the control group [(1.5 ± 0.4) mmol / L vs. (2.3 ± 0.4) mmol / L, P <0.05] (104 ± 21) ng / L and day 3 [(216 ± 100) ng / L vs. (354 ± 115) ng / L, P < The difference was lower than the conventional group [(13 ± 7) mmHg vs. (24 ± 15) mmHg]; (18 ± 7) mmHg vs. (26 ± 6) mmHg; P <0.05). Conclusion: BiPAP can simultaneously treat hypoxemia and reduce cardiac load in patients with chronic lung disease and heart failure, and then correct hypoxia and acidosis.