[1]靳中奎,李俊杰,杜德禄,等.无创正压通气治疗二尖瓣置换术后急性左心衰竭疗效观察[J].新乡医学院学报,2018,35(6):545-547.[doi:10.7683/xxyxyxb.2018.06.025]
　JIN Zhong-kui,LI Jun-jie,DU De-lu,et al.Clinical effect of non-invasive positive pressure ventilation for treatment of acute left heart failure after mitral valve replacement[J].Journal of Xinxiang Medical University,2018,35(6):545-547.[doi:10.7683/xxyxyxb.2018.06.025]
点击复制

无创正压通气治疗二尖瓣置换术后急性左心衰竭疗效观察
分享到：

《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
35
期数:
2018年6
页码:
545-547
栏目:
临床研究
出版日期:
2018-06-05

文章信息/Info

Title:
Clinical effect of non-invasive positive pressure ventilation for treatment of acute left heart failure after mitral valve replacement
作者:
靳中奎; 李俊杰; 杜德禄; 王世杰
(新乡市中心医院心胸外科,河南　新乡　453000)
Author(s):
JIN Zhong-kui; LI Jun-jie; DU De-lu; WANG Shi-jie
（Department of Cardio Thoracic Surgery，the Central Hospital of Xinxiang，Xinxiang 453000，Henan Province，China）
关键词:
无创正压通气; 二尖瓣置换术; 急性左心衰; N段脑钠肽前体
Keywords:
non-invasive positive pressure ventilation; mitral valve replacement; acute left heart failure; plasma brain natriuretic peptide
分类号:
R541
DOI:
10.7683/xxyxyxb.2018.06.025
文献标志码:
A
摘要:
目的　探讨无创正压通气（NPPV）治疗二尖瓣置换术后急性左心衰竭的临床效果。方法　选择2009年4月至2017年8月在新乡市中心医院心胸外科行二尖瓣置换术后出现急性左心衰竭的患者60例，根据治疗方法将患者分为对照组和NPPV组，每组30例。对照组患者给予面罩+鼻导管双路吸氧、强心、利尿、扩血管等治疗；NPPV组患者在对照组治疗基础上给予NPPV治疗。通过免疫荧光快速测定法检测2组患者治疗前及治疗后6、24 h血浆中N-端脑钠肽前体（NT-proBNP）水平，并监测患者治疗前及治疗后2、6、24 h时的呼吸频率、血氧饱和度、心率及氧分压等指标。结果　对照组和NPPV组患者的治疗总有效率分别为92.4%（26/28）、 96.6%（28/29），2组患者总有效率比较差异无统计学意义（χ2=1.25，P>0.05）。治疗前2组患者血浆NT-proBNP水平比较差异无统计学意义（P>0.05），2组患者治疗后6、24 h血浆NT-proBNP水平均低于治疗前（P<0.05）。治疗后6、24 h，NPPV组患者血浆中NT-proBNP水平低于对照组（P<0.05）。治疗前2组患者呼吸频率、血氧饱和度、心率及氧分压比较差异均无统计学意义（P>0.05）；2组患者治疗后2、6、24 h时的呼吸频率、心率显著低于治疗前，血氧饱和度及氧分压显著高于治疗前（P<0.05）。2组患者治疗后2 h氧分压比较差异无统计学意义（P>0.05）；NPPV组患者治疗后6、24 h氧分压显著高于对照组（P<0.05）；2组患者治疗后各时间点的呼吸频率、血氧饱和度及心率比较差异均无统计学意义（P>0.05）。结论　NPPV是一种有效的治疗二尖瓣置换术后急性左心衰的治疗方法。
Abstract:
Objective　To explore the clinical effect of non-invasive positive pressure ventilation(NPPV) for treatment of acute left heart failure after mitral valve replacement.Methods　Sixty patients with acute left heart failure after mitral valve replacement in Xinxiang Central Hospital from April 2009 to August 2017 were selected.The patients were divided into control group and NPPV group,with 30 patients in each group.The patients in the control group were treated with double oxygen absorption (mask and nasal catheter),strong heart,diuresis and dilated blood vessels.Based on the treatment of control group，the patients in NPPV group were treated with NPPV therapy.The plasma N-terminal pro-B-type natriuretic peptide（NT-proBNP）level of patients in the two groups was monitored by rapid determination of immunofluorescence before treatment and 6，24 hours after treatment.The respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure monitoring of patients in the two groups was monitored before treatment and 2,6 and 24 hours after treatment.Results　The total effective rate of patients in the control group and NPPV group was 92.4%(26/28) and 96.6%(28/29) respectively;there was no significant difference in the total effective rate between the two groups（χ2=1.25，P>0.05）.There was no significant difference in the plasma NT-proBNP level between the two groups before treatment (P>0.05);the level of NT-proBNP at 6,24 h after treatment was significantly lower than that before treatment in the two groups (P<0.05);the level of NT-proBNP of patients in the NPPV group was significantly lower than that in the control group at 6,24 h after treatment (P<0.05).There was no significant difference in the respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure between the two groups before treatment（P>0.05）.Compared with before treatment,the respiratory frequency and heart rate of patients were decreased and the blood oxygen saturation,oxygen partial pressure were increased at 2,6,24 h after treatment in the two groups (P<0.05).There was no significant difference in the oxygen partial pressure between the two groups at 2 h after treatment（P>0.05）;the oxygen partial pressure of patients in the NPPV group was significantly higher than that in the control group at 6,24 h after treatment（P<0.05）；there was no significant difference in the respiratory frequency,blood oxygen saturation and heart rate between the two groups at each time piont after treatment（P>0.05）.Conclusion　NPPV is an effective treatment for acute left heart failure after mitral valve replacement.

参考文献/References:

［1］　沈斌，戴莉莉，陈晓红，等.无创辅助通气治疗慢性阻塞性肺疾病合并急性左心衰竭的疗效［J］.临床肺科杂志，2013,18（3）:506-507.
［2］　叶任高，陆再英.内科学［M］.6版.北京：人民卫生出版社，2005:165-167.
［3］　GRUBITZSCH H,ANSORGE K,WOLLERT H G，et al.Stunned myocardium after off-pump coronary artery bypass grafting［J］.Annals of Thoracic Surgery,2001,71(1):352.
［4］　杨晓燕，张军汉，李海明，等.无创呼吸机改善重度心衰患者心功能临床观察［J］.内科，2010,5（4）:367-368.
［5］　MASSYOSHI Y,TOSHIAKI K,HIDETOSHI M,et al.Enhancenent of cardiac performance by bilevel positive airway pressure ventilation in heart failure［J］.J Card Fail，2012,18（12）：912-918.
［6］　刘东，李定武，张智喜.无创正压通气对急性左心衰患者血浆高敏肌钙蛋白T水平的影响［J］.中国全科医学，2011,14（17）:1908-1910.
［7］　中华医学会心血管分会，中华心血管病杂志委员会.中国心力衰竭诊断与治疗指南［J］.中华心血管病杂志，2014,42（2）:98-122.
［8］　周哲惠，宋雅欣，刘沁，等.NT-proBNP评估无创正压通气治疗急性左心衰的疗效［J］.血管康复医学杂志，2016,25（2）:167-171.
［9］　中华医学会心血管分会.慢性心力衰竭诊断与治疗指南［J］.中华心血管病杂志，2007,35（12）:1076-1079

更新日期/Last Update: 2018-06-05