Objective To investigate the effects of noninvasive positive pressure ventilation (NPPV) on patients with acute left heart failure. Methods Twenty patients with acute left heart failure diagnosed between September 2013 and July 2014 were randomized into treatment group (n=10) and control group (n=10). Both groups used conventional sedations, diuretics and drugs that strengthened the heart and dilated the vessels, while early use of NPPV was applied in the experimental group. Arterial blood gas analysis [pH value, pressure of arterial carbon dioxide (PaCO2), and pressure of arterial oxygen (PaO2)], heart rate (HR), respiration, duration of Intensive Care Unit (ICU) stay and invasive mechanical ventilation, duration of overall mechanical ventilation, and success case numbers before and two hours after treatment were observed and analyzed. Results For the control group, two hours after treatment, PaO2 was (67.0±8.5) mm Hg (1 mm Hg=0.133 kPa), HR was (124±10) times/min, Respiration was (34±4) times/min, the duration of ICU stay was (6.0±1.1) days, invasive ventilation was for (32.0±3.1) hours, and the total time of mechanical ventilation was (32.0±3.1) hours. Those indexes for the treatment group two hours after treatment were: PaO2, (82.3±8.9) mm Hg; HR, (98±11) times/min; respiration, (24±4) times/min; the duration of ICU stay, (4.0±0.8) days; invasive ventilation time, (16.0±1.3) hours; the total time of mechanical ventilation, (26.0±1.8) hours. All the differences for each index between the two groups were statistically significant (P < 0.05). Conclusion Early application of NPPV can rapidly relieve clinical symptoms and reduce the medical cost for patients with acute left heart failure.
目的 評價重癥急性左心衰竭患者機械通氣時采用咪達唑侖與嗎啡聯合持續鎮靜的效果。 方法 選擇2007年4月－2010年4月在重癥醫學科（ICU）進行有創機械通氣的重癥急性左心衰竭患者86例，隨機均分為咪達唑侖組（A組）、咪達唑侖聯合嗎啡組（B組）。采用Ramsay鎮靜評分，使每例患者鎮靜水平達RamsayⅢ～Ⅳ級。觀察起效時間、鎮靜時間、停藥后蘇醒時間和停藥后拔管時間；監測鎮靜12 h后的血氣分析及血流動力學參數的變化。 結果 B組起效時間、鎮靜時間、停藥后蘇醒時間和停藥后拔管時間明顯短于A組（P＜0.05）。且鎮靜12 h后B組血氣分析及血流動力學較A組明顯改善（P＜0.05）。 結論 重癥急性左心衰竭患者機械通氣時使用咪達唑侖聯合嗎啡鎮靜能達到滿意鎮靜效果，同時改善重癥急性左心衰竭患者的低氧血癥和高碳酸血癥。