|
|
|
| Clinical effect of PEEP mechanical ventilation in the treatment of acute left heart failure combined with cardiogenic shock and its effect on hemodynamics and blood gas status |
| ZHU Jingtao DU Panpan LIU Chengchan▲ |
| Department of Critical Care Medicine, Anhui Wanbei Coal and Power Group General Hospital, Anhui Province, Suzhou 234000, China |
|
|
|
Abstract Objective To investigate the clinical effect of positive end-expiratory pressure (PEEP) mechanical ventilation in the treatment of acute left heart failure combined with cardiogenic shock and its effect on hemodynamics and blood gas status. Methods A total of 80 patients with acute left heart failure combined with cardiogenic shock admitted to the Anhui Wanbei Coal and Power Group General Hospital from May 2018 to August 2020 were selected and divided into control group and observation group according to random number table method, with 40 cases in each group. The control group was given conventional basic treatment, and the observation group was given PEEP mechanical ventilation treatment. After one week of treatment, the clinical efficacy, hemodynamics (heart rate [HR], systolic blood pressure [SBP], dopamine) and blood gas status (artenal partial pressure of carbon dioxide [PaCO2], partial pressure of arterial oxygen (PaO2), PaO2/fraction of inspiration O2[FiO2] and pH value) before and after treatment were compared and analyzed between the two groups after one week of treatment. Results The total effective rate of the observation group was higher than that of the control group, and the difference was statistically significant (P ＜ 0.05). After treatment, the levels of HR and SBP in the observation group were higher than those in the control group, while the level of dopamine in the observation group was lower than that in the control group, and the differences were statistically significant (all P ＜ 0.05). After treatment, the level of PaCO2 in the observation group was lower than that in the control group, and the levels of PaO2, PaO2/FiO2 and pH value in the observation group were higher than those in the control group, and the differences were statistically significant (all P ＜ 0.05). Conclusion PEEP mechanical ventilation in the treatment of acute left heart failure combined with cardiogenic shock has a significant clinical effect, can promote the improvement of hemodynamics and blood gas status of patients, relieve clinical symptoms, and is worthy of clinical application.
|
|
|
|
|
|
[1] 丁琦，王淑红，黄新新，等.肺超声对急性左心衰竭患者治疗效果及预后的影响[J].中国急救医学，2018，38（11）：958-963.
[2] 刘学路，孟永.老年急性心肌梗死合并心源性休克患者经皮冠状动脉介入术后联合应用主动脉球囊反搏对术后的影响[J].中国老年学，2016，36（24）：6114-6116.
[3] Masip J，Peacock WF，Price S，et al. Indications and practical approach to non-invasive ventilation in acute heart failure [J]. Eur Heart J，2018，39（1）：17-25.
[4] 朱小琴，夏清德，师燕花，等.SIN-1在急性左心衰竭中的血流动力学效应的作用机制[J].基因组学与应用生物学，2019，38（10）：4660-4667.
[5] 中国医师协会急诊医师分会，中国心胸血管麻醉学会急救与复苏分会.中国急性心力衰竭急诊临床实践指南（2017）[J].中华急诊医学杂志，2017，26（12）：1347-1357.
[6] 中华医学会心血管病学分会，中华心血管病杂志编辑委员会.急性心力衰竭诊断和治疗指南（2010）[J].中国实用乡村医生杂志，2013，20（10）：7-11.
[7] Masip J. Noninvasive Ventilation in Acute Heart Failure [J].Curr Heart Fail Rep，2019，16（4）：89-97.
[8] 尚永志，冯雁，秦雷.IABP辅助直接PCI治疗急性ST段抬高型心肌梗死合并心源性休克的效果和危险因素分析[J].中国急救医学，2016，36（10）：918-923.
[9] Lacko S，Ml■ek M，Hála P，et al. Severe acute heart failure-experimental model with very low mortality [J]. Physiol Res，2018，67（4）：555-562.
[10] 吴晓燕，殷静静，於江泉，等. 不同机械通气模式对人机同步性以及膈肌功能影响的实验研究[J].中华医学杂志，2020，100（21）：1662-1667.
[11] Antonini L，Mollica C，Aspromonte N，et al. A simple prognostic index in acute heart failure [J]. Minerva Cardioangiol，2019，67（1）：73-78.
[12] 陈太碧，文英旭，邢柏，等.血清降钙素原对急性左心衰竭患者社区获得性肺炎的临床诊断研究[J].中华医院感染学杂志，2017，27（19）：4367-4370.
[13] Martín-González F，González-Robledo J，Sánchez-Hern-ández F，et al. Effectiveness and predictors of failure of noninvasive mechanical ventilation in acute respiratory failure [J]. Med Intensiva，2016，40（1）：9-17.
[14] 丁毅.托拉塞米注射液联合机械通气+PEEP治疗重症急性肺水肿疗效分析[J].中国急救医学，2016，36（z1）：234-235.
[15] 陈瑞娟，刘玉仁，郑永先，等.奈西立肽注射剂治疗急性心力衰竭的临床研究[J].中国临床药理学杂志，2018， 265（11）：11-13.
[16] Wang K，Samai K. Role of high-dose intravenous nitrates in hypertensive acute heart failure [J]. Am J Emerg Med，2020，38（1）：132-137.
[17] 姚滨，周荣，王建忠，等.呼吸机相关肺部感染对老年冠心病急性左心衰竭患者预后的影响[J].中国老年学杂志，2017，37（1）：75-77.
[18] 任高荆，丁士芳.无创呼吸机辅助救治急性左心衰竭的临床疗效[J].山东医药，2017，57（17）：72-74.
[19] 王永霞，朱明军，李彬.急性心力衰竭的中医药治疗及思考[J].中华中医药杂志，2017，32（8）：3569-3572.
[20] 高坡，江海龙，赵亚荣，等.急性左心衰伴垂体危象一例[J].中华医学杂志，2019，99（31）：2469-2470.
[21] Uriel N，Sayer G，Annamalai S，et al. Mechanical Unloading in Heart Failure [J]. J Am Coll Cardiol，2018，72（5）：569-580.
[22] Goenka L，George M，Selvarajan S. End points in heart failure-are we doing it right [J]. Eur J Clin Pharmacol，2017，73（6）：651-659.
[23] 周艺，王莹，何虹，等.新活素对急性心力衰竭患者临床症状及心功能的影响[J].中国急救医学，2018，38（z2）：49.
[24] 邓兵，刘萍.直接经皮冠状动脉介入治疗急性心肌梗死的研究进展[J].西部中医药，2020，33（2）：137-140.
[25] 林佑妮，杨敏，蔡裕福，等.优化后适应术式对急诊经皮冠状动脉介入术急性心肌梗死患者心肌再灌注损伤的影响[J].中国当代医药，2020，27（12）：70-73.
[26] 魏小红，刘文娴，陈立颖，等.急性心肌梗死合并心源性休克患者急诊冠脉介入术后院内死亡危险因素分析[J].中华急诊医学杂志，2019，28（5）：619-624.
[27] 刘婉嫣，马维辉，潘金龙.麻黄汤联合机械通气治疗急性心肌梗死并急性肺水肿患者的临床效果[J].世界中医药，2019，14（9）：2344-2348.
[28] Henes J，Rosenberger P. Systolic heart failure：diagnosis and therapy [J]. Curr Opin Anaesthesiol，2016，29（1）：55-60. |
|
|
|
