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目的加强对早期应用无创机械通气(NIV)治疗老年急性左心衰并呼吸衰竭的认识。方法回顾性分析1997年8月至2007年2月应用NIV治疗老年急性左心衰并呼吸衰竭患者32例,其中男22例,女10例,年龄(81.5±8.6)岁。研究分为两部分,第一部分:观察治疗前后所有患者喘鸣、呼吸、心率、血气分析、心功能分级变化及有效率;第二部分:根据开始使用NIV时间,分为早期应用NIV组(A组,n=17)及非早期应用NIV组(B组,n=15),比较两组病情好转时间、机械通气时间、有效率、插管率和死亡率。结果治疗后30例存活患者的心功能均有改善,由原来的心功能Ⅳ上升为Ⅰ～Ⅱ级,呼吸及心率显著性减慢,SaO_2和PaO_2显著性增加,原有PaCO_2增高者恢复到正常水平,有效率87.5%,插管率12.5%,死亡率6.3%。与B组比较,A组的病情好转时间、机械通气时间明显减少(P<0.01),全部治愈,无插管及死亡;B组11例治愈,插管4例,死亡2例。结论NIV治疗老年急性左心衰所致呼吸衰竭疗效确切,早期应用NIV可提高治愈,减少死亡。
Objective To strengthen the understanding of early application of noninvasive mechanical ventilation (NIV) in the treatment of elderly patients with acute left heart failure and respiratory failure. Methods A retrospective analysis of 32 patients with acute left heart failure and respiratory failure using NIV from August 1997 to February 2007 was retrospectively analyzed. There were 22 males and 10 females with a mean age of 81.5 ± 8.6 years. The study was divided into two parts. The first part was to observe the changes of wheeze, respiration, heart rate, blood gas analysis, heart function grading and efficiency in all patients before and after treatment. The second part: According to the time of starting NIV, (N = 17) and non-early application of NIV (n = 15 in group B). The improvement time, mechanical ventilation time, effective rate, intubation rate and mortality of the two groups were compared. Results After treatment, the cardiac function of all 30 survivors improved from the original cardiac function Ⅳ to grade Ⅰ ~ Ⅱ, the respiratory rate and heart rate decreased significantly, while SaO_2 and PaO_2 increased significantly, while those with increased PaCO_2 returned to normal Level, the effective rate of 87.5%, intubation rate of 12.5%, the mortality rate of 6.3%. Compared with group B, the condition of group A improved and time of mechanical ventilation decreased significantly (P <0.01), all were cured without intubation and death; in group B, 11 cases were cured, 4 cases were intubated and 2 died. Conclusion NIV is effective in treating respiratory failure caused by acute left heart failure in the elderly. Early application of NIV can improve the cure and reduce death.