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目的对比分析早期或延迟无创呼吸机治疗急性左心衰伴Ⅱ型呼吸衰竭的疗效。方法选取急性左心衰伴Ⅱ型呼吸衰竭患者194例,随机分为临床组和对照组,每组97例。对照组给予常规治疗及鼻导管吸氧,1~2 h后无改善再实施无创呼吸机通气治疗;临床组给予常规治疗的同时,直接实施无创呼吸机通气治疗。记录两组治疗前后心率、呼吸、平均动脉压、动脉氧分压,比较两组治疗总有效率、住院时间、气管插管或切开例数及比率。结果临床组和对照组心率、呼吸、平均动脉压及动脉氧分压比治疗前均显著改善,差异有统计学意义(P均<0.05),临床组上述指标改善程度均优于对照组,差异有统计学意义(P均<0.05)。临床组住院时间(11.5±3.1)d,对照组(17.8±2.6)d,差异有统计学意义(P<0.05)。临床组总有效率82.47%(80/97),对照组52.58%(51/97),差异有统计学意义(P<0.05)。临床组气管插管或切开17例(17.53%),对照组46例(47.42%),差异有统计学意义(P<0.05)。结论急性左心衰伴Ⅱ型呼吸衰竭患者早期应用呼吸机治疗,可更有效改善症状、体征、血气指数,纠正低氧血症,在显著缩短病程的同时降低气管插管或气管切开的发生率,值得临床推广应用。
Objective To compare and analyze the curative effect of early or delayed noninvasive ventilator on acute left heart failure with type Ⅱ respiratory failure. Methods 194 patients with acute left heart failure and type Ⅱ respiratory failure were randomly divided into clinical group and control group, 97 cases in each group. The control group was given routine treatment and nasal catheter oxygen, no improvement after 1 ~ 2 h and then noninvasive ventilator ventilation treatment; clinical group given conventional treatment at the same time, the direct implementation of noninvasive ventilator ventilation treatment. The heart rate, respiration, mean arterial pressure and arterial oxygen pressure were recorded before and after treatment. The total effective rate, hospitalization time, endotracheal intubation or incision number and ratio were compared between the two groups. Results The heart rate, respiration, mean arterial pressure and arterial partial pressure of oxygen of the clinical group and the control group were significantly improved than those before treatment (all P <0.05), and the improvement of the above indexes in the clinical group was better than that in the control group There was statistical significance (all P <0.05). The length of stay in the clinical group (11.5 ± 3.1) d and the control group (17.8 ± 2.6) d were significantly different (P <0.05). The total effective rate was 82.47% (80/97) in the clinical group and 52.58% (51/97) in the control group, the difference was statistically significant (P <0.05). In the clinical group, 17 cases (17.53%) were intubated or incised and 46 cases (47.42%) in the control group, the difference was statistically significant (P <0.05). Conclusion Early application of ventilator in patients with acute left heart failure and type Ⅱ respiratory failure can improve symptoms, signs, blood gas index and correct hypoxemia effectively, reduce the duration of tracheal intubation or tracheotomy significantly Rate, it is worth clinical application.
