吗啡提高无创正压机械通气治疗急性左心衰竭临床效果研究

发布时间：2018-04-24 21:12

本文选题：吗啡 + 无创正压机械通气　；参考：《青岛大学》2013年硕士论文

【摘要】：目的观察吗啡镇静提高无创正压机械通气治疗急性左心衰患者的临床效果,为临床经验性治疗提供依据。方法选择2011年9月—2012年6月入住我院的急性左心衰竭病人32例,其中男19例,女13例。将32例急性左心衰竭病人随机分为吗啡组和对照组各16例,对照组给予常规利尿、强心和无创正压通气治疗。吗啡组在对照组治疗的基础上持续静脉输注吗啡(5ug. kg-1. h-1)。无创正压通气设置；持续气道正压+压力支持模式(CPAP+PS模式),压力支持(PS)8cmH2O,呼气末压力(PEEP)由4cmH2O开始逐渐增加至6cmH2O,吸氧浓度(Fi02)30%～60%,通过调节吸入氧浓度维持目标值SpO2＞90%。呼吸监测每次分别自主吸呼气量和分钟通气量。对照组使用机械通气记录使用期间上述指标的变化。吗啡组在使用机械通气前首先静脉注射吗啡3mg,继以5ug·kg-1·h-1恒速静脉泵入,应用统计学方法比较两组间治疗前后24小时患者生命体征、机械通气效果、动脉血气分析、呼吸循环功能及血清BNP的变化。结果 1、吗啡组治疗30min后,患者的心率、呼吸频率均有改善(P＜0.05),动脉血气分析显示PaO：明显增加,PaCO2明显下降,pH值恢复正常(P＜0.05～0.01),治疗24h后血清BNP明显下降,氧合指数、尿量明显升高,心功能评分均明显改善(P＜0.01)。 2、对照组治疗30min后心率、呼吸频率及动脉血气指标轻度改善(P＜0.05),治疗24h后血清BNP轻度下降,氧合指数及尿量轻度升高,心功能评分轻度改善。 3、吗啡组治疗30min后心率、呼吸频率、动脉血气指标、心肌耗氧指标改善均优于对照组,差异有统计学意义(t=2.32～16.29,P＜0.05～0.01)。吗啡组治疗24h后血清BNP、氧合指数、尿量及心功能改善均优于对照组,差异有统计学意义(t=7.82～15.34,P＜0.01)。 4、BNP作为心衰的生物标志物,对急性左心衰竭诊断和鉴别诊断有肯定的价值,急性左心衰患者血清BNP水平显著升高,两组在治疗前血清BNP水平差异无统计学意义(P＞0.05),治疗24h后,治疗组血清BNP水平显著低于对照组(P＜0.01)。 5、吗啡组治疗30min后16例患者胸闷及呼吸困难显著缓解,肺部Up音显著减少甚至消失,机械通气适应度和通气效果明显优于对照组,且无不良反应。对照组治疗30min后13例患者病情有所缓解,2例患者因病情需行气管插管机械通气,1例患者因并发严重心律失常死亡。结论吗啡不仅有良好的镇静和改善心功能的效果而且能提高机械通气效率,并无不良反应,对于急性左心衰竭病人,在常规治疗的基础上建议运用无创正压机械通气联合吗啡进行治疗,这样能够迅速纠正低氧血症,缓解急性左心衰竭病人的临床症状,是临床一种有效的治疗方法。
[Abstract]:Purpose To observe the clinical effect of morphine sedation in the treatment of acute left heart failure by non-invasive positive pressure mechanical ventilation. Method Thirty-two patients with acute left ventricular failure admitted to our hospital from September 2011 to June 2012 were selected, including 19 males and 13 females. 32 patients with acute left ventricular failure were randomly divided into morphine group (n = 16) and control group (n = 16). The control group was treated with routine diuretic, cardiac strengthening and noninvasive positive pressure ventilation. In morphine group, 5 渭 g 路kg -1 路h -1 of morphine was continuously infused intravenously on the basis of treatment in the control group. Continuous positive airway pressure (CPAP PS mode), pressure support (PS8 cm H 2O), end expiratory pressure (PEEP) gradually increased from 4cmH2O to 6cm H 2O, oxygen concentration (Fi02C 3030) was increased to 6cm H 2O, and the target value SpO2 > 90 was maintained by adjusting the oxygen concentration of inhaled oxygen. Breath monitoring was performed on each time with spontaneous expiratory volume and minute ventilation volume, respectively. The changes of the above indexes during the use of mechanical ventilation were recorded in the control group. Before using mechanical ventilation, morphine 3 mg was injected intravenously in morphine group, followed by intravenous infusion of 5ug kg-1 h-1 at constant velocity. The vital signs, mechanical ventilation effect and arterial blood gas analysis were compared between the two groups before and after 24 hours of treatment. Changes of respiratory and circulatory function and serum BNP. Result 1. After treatment with 30min, the heart rate and respiratory rate of morphine group were improved (P < 0.05). Arterial blood gas analysis showed that Pao: Pao: Pao: Pao: Pao: Paco _ 2 decreased significantly and pH value returned to normal (P < 0.05). After 24 hours of treatment, serum BNP decreased significantly, oxygenation index and urine volume increased significantly. Cardiac function scores were significantly improved (P < 0.01). 2. In the control group, the heart rate, respiratory rate and arterial blood gas index were slightly improved after treatment with 30min (P < 0.05). After 24 hours of treatment, the serum BNP decreased slightly, the oxygenation index and urine volume increased slightly, and the cardiac function score was slightly improved. 3. The improvement of heart rate, respiratory rate, arterial blood gas index and myocardial oxygen consumption index in morphine group was better than that in control group after treatment with 30min. The difference was statistically significant (P < 0.05). The improvement of serum BNP, oxygenation index, urine volume and cardiac function in morphine group was better than that in control group 24 hours after treatment, and the difference was statistically significant (P < 0.01). 4BNP, as a biomarker of heart failure, has positive value in the diagnosis and differential diagnosis of acute left heart failure. The serum BNP level in patients with acute left heart failure was significantly increased. There was no significant difference in serum BNP levels between the two groups before treatment (P > 0.05). 24 hours after treatment, there was no significant difference in serum BNP levels between the two groups. The serum BNP level in the treatment group was significantly lower than that in the control group (P < 0.01). 5. In morphine group, chest tightness and dyspnea in 16 patients with 30min were significantly alleviated, but lung up tone was decreased or even disappeared. Mechanical ventilation fitness and ventilation effect were significantly better than those in control group, and there was no adverse reaction. In the control group, 13 patients had remission after 30min, 2 patients needed mechanical ventilation with endotracheal intubation, 1 patient died of severe arrhythmia. Conclusion Morphine not only has good sedation and heart function improvement effect, but also can improve the mechanical ventilation efficiency, there is no adverse reaction, in patients with acute left heart failure, On the basis of routine treatment, it is suggested that non-invasive positive pressure ventilation combined with morphine should be used to correct hypoxemia rapidly and relieve the clinical symptoms of patients with acute left heart failure. It is an effective clinical treatment method.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R541.6

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