双水平气道正压通气治疗高龄心力衰竭的临床观察

Efficacy and safety of bilevel positive airway pressure ventilation in elderly patients with acute exacerbation of heart failure

摘要:

目的 探讨双水平气道正压通气（BiPAP）对高龄慢性心力衰竭急性加重期患者辅助治疗的有效性及安全性。方法 分析2011年7月至2012年12月期间在武汉市亚心七医院心内科住院的40例慢性心力衰竭急性加重期的高龄患者[男22例，女18例，年龄（79.0±5.5）岁]的临床资料，对比分析使用BiPAP治疗前、后临床参数的变化（包括呼吸频率、血压、心率、血氧饱和度、血气分析、氨基端脑钠肽前体水平、心功能NYHA分级），统计气管插管率、呼吸机相关并发症发生率。结果 与治疗前相比，BiPAP治疗后动脉血气分析氧分压、血氧饱和度均升高（P＜0.001）；收缩压、舒张压、心率、呼吸频率、心功能分级、氨基端脑钠肽前体水平均下降（P＜0.01）；治疗有效38例，气管插管2例；死亡2例。无呼吸机相关性肺炎、恶性心律失常、新发心肌梗死病例。结论 BiPAP辅助治疗能够改善高龄心力衰竭急性加重期患者的多项临床参数，迅速、安全地改善患者的心肺功能。

Abstract:

Objective To evaluate the efficacy and safety of bilevel positive airway pressure (BiPAP) ventilation as adjuvant therapy in the aged patients with acute exacerbation of chronic heart failure. Methods A total of 40 aged patients with acute exacerbation of chronic heart failure admitted in our department from July 2011 to December 2012 were enrolled in this study. There were 22 males and 18 females, with the age of (79.0±5.5)years. Their respiratory rate, blood pressure, heart rate, pulse oxygen saturation, arterial blood gas analysis, serum level of N-terminal pro-brain natriuretic peptide (NT-pro-BNP), and the class of New York Heart Association (NYHA) before and after BiPAP ventilation were recorded and compared. The rates of endotracheal intubation and complications after BiPAP ventilation were analyzed. Results After BiPAP ventilation, arterial partial pressure of oxygen, and arterial oxygen saturation were elevated compared with those before treatment (P＜0.001), but, systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, NYHA class, and serum level of NT-pro-BNP were reduced (P＜0.01). Of all patients, 38 cases were effective to BiPAP ventilation, and 2 cases required endotracheal intubation. Two patients died in hospital. No breathing machine-related pneumonia, severe arrhythmia, or newly occurred myocardial infarction was found. Conclusion BiPAP, as an adjuvant therapy, improves the clinical symptoms in the elderly patients with acute exacerbation of heart failure, and promotes the heart and lung function rapidly and safely.