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目的:观察双水平气道内正压通气(BiPAP)治疗尿毒症合并左心衰竭患者的临床疗效。方法:选取82例确诊为尿毒症合并左心衰竭的患者,在患者进行常规的强心、利尿、扩血管、持续性肾替代治疗(CRRT)30 min后无缓解后,立即对患者进行BiPAP治疗。比较患者在常规治疗30 min末、BiPAP治疗后1 h、2 h后收缩压、舒张压、心率、呼吸频率、二氧化碳分压(PaCO_2)、动脉血氧分压(PaO_2)等指标的变化,以及常规治疗30 min末、BiPAP治疗2h后的血浆脑钠肽(BNP)、血乳酸(Lac)水平和临床表现的变化。结果:经Bi PAP治疗后患者症状和体征缓解的有效率为93.90%。BiPAP治疗1 h、2 h后与常规治疗30 min末比较,患者的收缩压、舒张压、心率、呼吸频率具有显著下降(P<0.05),PaO_2则显著升高(P<0.05),PaCO_2的变化经比较则无显著的统计学意义(P>0.05)。BiPAP治疗2 h后患者的血浆BNP、Lac水平与常规治疗30 min末比较均显著下降(P<0.05)。结论:BiPAP治疗尿毒症并发急性左心衰竭患者可有效改善患者的症状和体征,改善心功能,适合在临床上推广应用。
Objective: To observe the clinical effect of bi-level positive airway pressure (BiPAP) in treating uremic patients with left ventricular failure. Methods: 82 patients diagnosed as uremia with left ventricular failure were enrolled. Patients were treated with BiPAP immediately after 30 min of conventional cardiac, diuretic, vasodilator and continuous renal replacement therapy (CRRT) without remission . The changes of systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, PaCO_2 and PaO_2 were compared between the end of 30-minute routine treatment and 1 and 2 hours after BiPAP treatment. At the end of routine treatment for 30 min, the levels of plasma brain natriuretic peptide (BNP), blood lactic acid (Lac) and clinical manifestations after 2-hour BiPAP treatment were observed. Results: The effective rate of symptom and symptom relief after treatment with Bi PAP was 93.90%. Systolic blood pressure, diastolic blood pressure, heart rate and respiratory rate were significantly decreased (P <0.05), PaO_2 was significantly increased (P <0.05), PaCO_2 was significantly higher in patients treated with BiPAP at 1 h and 2 h Changes after the comparison was not statistically significant (P> 0.05). Plasma BNP and Lac levels in patients treated with BiPAP for 2 h decreased significantly compared with the end of 30 min (P <0.05). Conclusion: BiPAP treatment of uremic patients with acute left heart failure can effectively improve the symptoms and signs of patients, improve cardiac function, suitable for clinical application.