摘要
目的比较无创压力支持通气(NPSV)与常规内科治疗顽固性左心衰的临床疗效。方法选择符合本研究顽固性左心衰入选标准者92例,随机分成NPSV组47例及常规治疗组45例,分别予以经鼻面罩BiPAP辅助通气及常规内科治疗。结果NPSV组44例、常规治疗组39例经治疗后好转出院(P>0.25),而NPSV组起效快,治疗2h后血气、PaO2/FiO2、呼吸频率(RR)、心率(HR)及气急指数均较治疗前显著改善(P<0.01),达好转33例,而常规治疗组16例,两者有显著性差异(P<0.005);NPSV组住院时间、住院费用明显少于常规治疗组(P<0.001)。在高碳酸血症亚组,NPSV组更快改善二氧化碳分压,气管插管率显著低于常规治疗组(P<0.01)。NPSV组未发生严重并发症,常规治疗组出现较严重并发症。结论顽固性左心衰早期应用无创压力支持通气能加速改善血气、PaO2/FiO2、RR、HR及气急指数,缩短住院时间,减少住院费用;在合并高碳血症亚组,能降低气管插管率。
Objective To compare the clinical efficacy of noninvasive pressure support ventilation and conventional medical therapy in refractory left heart failure. Methods A total of 92 patients enrolled in the study had diagnosed as refractory left heart failure. All patients were randomly assigned to receive either Bi- level postive airway pressure assisted ventilation through nasal - face mask （NPSV group, 47 patients） or conventional medical therapy （conventional therapy group, 45 patients）. Results 44 NPSV patients （93.6%） and 39 conventional therapy patients （86.7%） had improved conditions with their therapy and discharged from the hospital successfully （ P 〉 0.25）. however, the level of blood gas analysis, PaO2/Fi02, respiratory rate, heart rate ,and dyspnea index after 2h in NPSV group improved significantly faster than that of in conventional therapy group . 33 NPSV patients （70.2%） and 16 conventional therapy patients （35.6%）were fully better（ P 〈 0.005）. NPSV group is more less than conventional therapy group in Length of hospital stay and Cost of hospitalization（ P 〈 0.1301 ）. In the subgroup of hypercapnia patients, NSPV improved PaCO2 significantly faster and reduced the intubation rate compared with conventional therapy （P 〈 0.01 ）. There were not severe complications in NPSV group. A few severe complications appeared in conventional therapy group. Conclusions The early use of noninvasive pressure support ventilation in refractory left heart failure accelerates the improvement in blood gas analysis, PaO2/FiO2, respiratory rate, heart rate ,and dyspnea index, shorten the length of hospital stay and reduces the cost of hospitalization. Noninvasive pressure support ventilation does, however, reduce the intubation rate in the subgroup of hypercapnia patients.
出处
《浙江临床医学》
2005年第9期903-904,共2页
Zhejiang Clinical Medical Journal
