文章摘要
戴山林,金 宇,孔 辉.无创正压通气治疗Ⅱ型呼吸衰竭合并急性左心功能不全的疗效观察[J].南京医科大学学报,2013,(11):1537~1540
无创正压通气治疗Ⅱ型呼吸衰竭合并急性左心功能不全的疗效观察
The curative effect of noninvasive positive pressure ventilation in the treatment of Type II respiratory failure combined with acute left heart dysfunction
投稿时间:2013-05-13  
DOI:10.7655/NYDXBNS20131110
中文关键词: 无创通气  慢性阻塞性肺疾病  呼吸衰竭  左心功能不全
英文关键词: NIPPV  COPD  respiratory failure  left heart dysfunction
基金项目:
作者单位
戴山林 南京医科大学第一附属医院呼吸科RICU,江苏 南京 210029 
金 宇 南京医科大学第一附属医院呼吸科RICU,江苏 南京 210029 
孔 辉 南京医科大学第一附属医院呼吸科RICU,江苏 南京 210029 
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中文摘要:
      目的:观察无创正压通气(NIPPV)对重症慢性阻塞性肺疾病(COPD)所致Ⅱ型呼吸衰竭合并急性左心功能不全的治疗效果。方法:86例COPD合并急性左心功能不全患者分为治疗组43例和对照组43例,对照组给予常规治疗,治疗组给予双水平气道正压通气(BiPAP) + 常规治疗。治疗组进行经鼻(面)罩BiPAP,第1~2天给予持续通气,第3天后每日通气8~20 h不等,病情稳定后逐步撤机。监测治疗前与治疗后2 h?24 h?48 h?7 d时心率(HR)?血气分析及临床症状变化情况(包括呼吸困难?意识状态?肺部啰音等)。治疗前与治疗后7 d时进行心脏超声心动图测定左心室射血分数(LVEF),治疗前与治疗后48 h?7 d时测定血浆NT-proBNP浓度。结果:治疗组患者在治疗前与治疗后2 h?24 h?48 h?7 d时,其HR?pH?PaO2?PaCO2均较对照组明显好转(P < 0.05);治疗组7 d时LVEF值较对照组明显改善(P < 0.05);治疗组48 h?7 d时NT-proBNP值较对照组均明显下降(P < 0.05)。 结论:BiPAP治疗重症COPD所致Ⅱ型呼吸衰竭合并急性左心功能不全具有较好的疗效。
英文摘要:
      Objective:To observe the curative effect of noninvasive positive pressure ventilation (NIPPV) in the treatment of severe COPD-induced type II respiratory failure combined with acute left heart dysfunction. Methods:Eighty-six COPD patients with acute left heart dysfunction were randomly divided into control group (n = 43) and treatment group (n = 43). The control group was treated with routine treatment,and the treatment group was treated with bi-level positive airway pressure (BiPAP) ventilation through a nasal or face mask in addition to routine treatment. For the treatment group,continuous BiPAP ventilation was given in the first 2 days. Since the third day,the patients were given 8 to 20 hours BiPAP ventilation. BiPAP ventilation was gradually weaned when patient's condition stabilized. Changes of heart rate,blood gas indexes,left ventricular ejection fraction (LVEF),NT-proBNP,and clinical symptoms (including dyspnea,conscious state,pulmonary rales) in the two groups before and after the treatment were compared. Results:The heart rate,pH,PaO2,PaCO2 in the treatment group after BiPAP ventilation for 2 h,24 h,48 h,and 7 d were significantly improved compared to those of the control group (all P < 0.05). The LVEF values of 7 days after BiPAP ventilation in the treatment group were significantly increased than that of the control group. Moreover,the NT-proBNP levels of the treatment group were significantly decreased compared to the control group after 48 hours and 7 days treatment. Conclusion:BiPAP ventilation had a good therapeutic effect for patients with severe COPD-induced type II respiratory failure combined with acute left heart dysfunction.
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