目的 探讨BiPAP无创通气在治疗左心衰竭合并低氧血症中的作用.方法 2008年6月至2010年9月收治的34例急性左心衰竭患者,按随机数字表法分为BiPAP无创通气组18例和常规治疗组16例.2组患者均给予心电监测,持续动脉血气分析,均给予强心、利尿、扩血管等常规药物治疗.常规治疗组选择鼻导管高流量供氧(6 L·min-1),BiPAP无创通气组选择连接BiPAP呼吸机.结果 治疗1、6h后,2组动脉血氧分压(PaO2)、末梢血氧饱和度(SaO2)显著升高,心率、呼吸频率明显降低(均P＜0.01)；与常规治疗组相比,治疗1、6h后BiPAP无创通气组PaO2、SaO2升高更明显,心率、呼吸频率降低更明显而至正常水平(均P＜0.01).治疗1h后BiPAP无创通气组总有效率(88.9％)明显高于常规治疗组(50.0％) (P＜0.05)；BiPAP无创通气组有2例(11.1％)、常规治疗组有8例(50.0％)病情未见好转予以气管插管转成有创通气,2组气管插管率比较差异有统计学意义(P＜0.05).结论 与常规药物治疗比较,BiPAP无创通气治疗更有利于病情缓解,对提高抢救危重心力衰竭患者的成功率有重要价值.%Objective The investigate the adjuvant treatment of acute left heart failure complicated by hypoxemia with noninvasive BiPAP ventilation. Methods Thirty-four patients with a-cute left ventricular failure treated in our hospital from June 2008 to September 2010 were randomly divided into two groups. All patients received ECG monitoring, continuous arterial blood gas analysis and the treatment with cardiotonics, diuretic, vasodilator and other conventional drugs. Control group (n=16) was given high-flow oxygen by nasal catheter(6 L ? min-1) and BiPAP treatment group(n=18) was given oxygen by BiPAP breathing machine. Results Values of PaO2 and SaO2 significantly increased but heart rate and respiratory rate obviously decreased in both groups after treatment for 1 and 6 hours(P<0. 01). Compared with control group,noninvasive BiPAP ventilation induced significant increase in PaO2 and SaO2 and obvious decrease in heart rate and respiratory rate(P<0. 01). After treatment for 1 hour,the total effective rate in BiPAP treatment group was significantly higher than that in control group(88. 9% vs 50. 0% ,P<0. 05). Two patients in BiPAP treatment group (11. 1%) and 8 patients in control group(50. 0%)were converted to receive endotracheal intubation due to ineffective treatment. There was a significant difference in endotracheal intubation rate between the two groups(P<0. 05). Conclusion Compared with conventional drug therapy,noninvasive BiPAP ventilation is more conducive to remission of acute left heart failure. Therefore, noninvasive BiPAP ventilation has great value for improving the survival rates in patients with heart failure.
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