家庭无创正压通气对慢性左心衰的疗效观察

发布时间：2018-05-25 03:39

本文选题：家庭无创正压通气 + 慢性左心衰竭　；参考：《河北医科大学》2017年硕士论文

【摘要】：目的:慢性左心衰由多种心脏疾病逐渐进展到严重的阶段出现的,患病人数多,死亡率高,具有复杂的临床症状。有效防治慢性左心衰的方法是医务人员不断探索的。最初慢性左心衰的治疗是以改善血流动力学为主,随着临床经验的积累及临床治疗的进展,开始发展到拮抗神经-内分泌方面的治疗,从而延缓了慢性左心衰的进展速度,有效的降低了该病的死亡率。最近几年,越来越多的医务工作者开始研究非药物治疗慢性左心衰的方法并付诸实践。于是,家庭无创通气作为治疗慢性左心衰的方法之一逐渐浮出水面。呼吸系统和循环系统之间是相互作用与影响的,无创通气可以通过改善呼吸功能而改善心脏功能,基于上述理论,无创通气在慢性左心衰治疗中起到了不可替代的作用。本研究通过探讨家庭无创正压通气在慢性左心衰中的治疗效果,体现无创通气在慢性左心衰的应用价值。从而为慢性左心衰患者的治疗增加一种更为方便、可靠的方法,提高患者生存率,改善其生活质量。方法:1病例选择:选择就诊于保定市第一医院的慢性左心衰患者31例,于2016年1月-2016年12月进行观察。其中男18例,女13例,年龄61-75岁,平均年龄69.37岁。入选标准:(1)所有病例均符合慢性左心衰的诊断标准;(2)依据纽约心脏病协会(NYHA)的评价标准,所有患者心功能分级属于III级-IV级;(3)患者自愿参加本研究。排除标准:(1)培训后,仍不能正确使用无创呼吸机者;(2)面部有手术、创伤或者畸形,不能满意佩戴面罩者;(3)因合并青光眼、血压控制差、胃肠胀气不易缓解而不能进行无创通气者;(4)除外右心衰及全心衰者。2通气治疗:将患者分为对照组和治疗组,对照组给予常规抗心衰药物治疗,治疗组在常规药物治疗的基础上,加用双水平气道正压通气(BiPAP)的无创呼吸机。参数设置:模式为自主呼吸/时间控制自动切换(S/T),初始呼气压(EPAP)4cm H20(1cmH20=0.098KPa),逐渐增加至4-8cmH20;初始吸气压(IPAP)8cmH20,间隔时间大于5-10min后再逐渐增加(每次2cmH20),直到患者症状好转。根据患者的末梢血氧饱和度调节吸氧流量,以维持末梢血氧饱和度波动于90%以上。要求患者间断应用NPPV,每次使用的持续时间约2h左右。尽量保证患者进餐、交谈等个人活动。根据患者病情及对呼吸机的耐受情况决定每个患者具体的应用时间,但每天应用呼吸机总的治疗时间应大于8h。依据患者病情及呼吸机使用情况,不定期电话或上门随访患者一般情况及呼吸机使用过程中的问题,确保患者病情稳定及呼吸机正常使用。3终点观察指标:患者住院、插管或死亡。4观察指标:观察治疗1年后患者的临床症状、动脉血氧分压、6分钟步行试验、脑钠肽、左室射血分数。5统计方法:应用SPSS13.0软件包进行统计学分析。计量资料以均数±标准差表示,治疗前后比较采用t检验,以P0.05认为统计学上有显著性差异。结果:1治疗组15例患者均能配合完成HNPPV治疗,对无创通气耐受良好,依从性好。治疗1年后:PaO2,对照组56.32±3.75mmHg,治疗组69.52±2.71mmHg,较对照组明显升高,两组比较统计上有显著性差异(P0.05);6MWT,对照组243.42±50.13m,治疗组302.72±60.23m,较对照组明显增加,两组比较统计上有显著性差异(P0.05);BNP,对照组421.42±30.78pg/mL,治疗组235.72±28.52pg/mL,较对照组明显下降,两组比较统计上有显著性差异(P0.05);左室射血分数,对照组40.25±9.79%,治疗组48.89±10.11%,较对照组明显升高,两组比较统计上有显著性差异(P0.05);2治疗期间治疗组无失访者,对照组失访1例,失访原因为死亡。结论:长期家庭无创正压通气治疗可以改善患者临床症状、PaO2、6MWT、BNP、LVEF,从而改善其心功能。
[Abstract]:Objective: chronic left heart failure is progressing from a variety of heart diseases to a serious stage. The number of patients, the high mortality, and the complicated clinical symptoms. The method of effective prevention and treatment of chronic left heart failure is the medical staff to explore. The initial treatment of chronic left heart failure is to improve the hemodynamics, with the accumulation of clinical experience. And the progress of clinical treatment began to develop to antagonistic neuroendocrine therapy, which slowed down the speed of chronic left heart failure and effectively reduced the mortality of the disease. In recent years, more and more medical workers began to study the methods of non drug treatment for chronic left heart failure and put it into practice. One of the ways to treat chronic left heart failure gradually emerges. There is interaction and influence between the respiratory system and the circulatory system. Noninvasive ventilation can improve the function of the heart by improving the respiratory function. Based on the above theory, noninvasive ventilation plays an irreplaceable role in the treatment of chronic left heart failure. This study is based on the study of the family. The therapeutic effect of noninvasive positive pressure ventilation in chronic left heart failure reflects the application value of noninvasive ventilation in chronic left heart failure. Thus, a more convenient and reliable method for the treatment of chronic left heart failure is added to improve the survival rate and improve the quality of life. Method: 1 cases selection: choose the chronic Baoding First Hospital 31 patients with left heart failure were observed in December -2016 January 2016. Among them, 18 men, 13 women, 61-75 years old and 69.37 years old. (1) all cases were in accordance with the criteria for diagnosis of chronic left heart failure; (2) according to the evaluation criteria of the New York Heart Association (NYHA), all patients' cardiac function classification was grade III -IV; (3) patients self We would like to take part in this study. (1) after training, the non invasive ventilator is still not used correctly; (2) the face has surgery, trauma or deformity and can not be satisfied with the mask; (3) the patients with glaucoma, poor blood pressure control, and flatulence are not easy to relieve without non-invasive ventilation; (4) except for right heart failure and heart failure.2 ventilation treatment: will suffer The control group was divided into the control group and the treatment group. The control group was given the conventional anti heart failure drug treatment. On the basis of the conventional drug treatment, the treatment group was added to the noninvasive ventilator with double level positive airway pressure ventilation (BiPAP). The parameters were set: the mode was automatic breathing / time control automatic switching (S/T), and the initial air pressure (EPAP) 4cm H20 (1cmH20=0.098KPa) increased gradually. To 4-8cmH20; initial suction pressure (IPAP) 8cmH20, the interval time is more than 5-10min and then gradually increase (2cmH20), until the patient's symptoms improve. According to the patient's end of oxygen saturation to adjust the oxygen flow, to maintain the end of oxygen saturation of more than 90%. Require patients to discontinuous use of NPPV, the duration of each use about 2H. Quantity ensures the patient's meal, conversation and other personal activities. Depending on the patient's condition and the endurance of the ventilator, the patient's application time is determined, but the daily use of the ventilator should be more than 8h. based on the condition of the patient and the use of the ventilator, the general situation of the irregular telephone or the follow-up patients and the use of the ventilator. The problems in the course were to ensure the stability of the patient's condition and the normal use of the.3 end point of the ventilator: Patients hospitalization, intubation or death.4 observation index: the clinical symptoms, arterial oxygen pressure, 6 minute walking test, brain natriuretic peptide, left ventricular ejection fraction.5 statistical method after 1 years of treatment: statistical analysis with SPSS13.0 software package. T test was used before and after treatment. The results showed that there were significant differences between the 15 patients in the 1 treatment group. The results showed that 15 patients in the 1 treatment group were able to cooperate with the treatment of non invasive ventilation with good compliance and good compliance. After 1 years of treatment, PaO2, the control group was 56.32 + 3.75mmHg, and the treatment group was 69.52 + 2.71mmHg, obviously more than the control group. The two groups were statistically significant differences (P0.05); 6MWT, the control group was 243.42 + 50.13m, the treatment group was 302.72 + 60.23m, the comparison group was significantly increased, the two groups were statistically significant differences (P0.05), BNP, the control group 421.42 + 30.78pg/mL, 235.72 + 28.52pg/mL in the treatment group, compared with the control group, the two groups were statistically significant. The difference (P0.05), left ventricular ejection fraction, 40.25 + 9.79% in the control group, 48.89 + 10.11% in the treatment group, significantly higher in the control group than in the control group (P0.05); the treatment group in the 2 treatment group had no loss of visits, the control group lost 1 cases and the cause of the loss was death. Shape, PaO2,6MWT, BNP, LVEF, so as to improve their heart function.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R541.6

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