无创呼吸机辅助通气联合吗啡治疗急性左心衰竭的临床效果

黄佐才　徐招柱　刘德忠　李国贤?王东晓

[摘要] 目的 探讨无创呼吸机辅助通气联合吗啡治疗急性左心衰竭的临床效果。 方法 选取2014年1月～2015年12月本院收治的180例急性左心衰竭患者为研究对象，按照随机数字表法分为试验组和对照组，每组各90例，对照组患者给予无创呼吸机辅助通气治疗，试验组患者在对照组的基础上加用吗啡治疗，观察并比较两组患者的临床疗效、不良反应以及监测指标的改善情况。 结果 对照组患者的总有效率为74.4%，明显低于试验组的90.0%，两组间比较差异有统计学意义（P<0.05）；对照组患者的不良反应发生率为35.6%，与试验组的36.7%比较，差异无统计学意义（P>0.05）；治疗后试验组患者的DBP、SBP、HR、RR、BNP、PaCO2均明显低于对照组，PaO2、PaO2/FiO2明显高于对照组，两组间差异有统计学意义（P<0.05）。试验组治疗后APACHEⅡ评分明显低于对照组，差异有统计学意义（P<0.05）。 结论 无创呼吸机辅助通气联合吗啡治疗急性左心衰竭能有效改善患者的症状，临床效果显著，且不增加不良反应。

[关键词] 无创呼吸机；吗啡；急性左心衰竭；辅助通气

[中图分类号] R541.6 [文献标识码] B [文章编号] 2095-0616（2016）09-207-04

[Abstract] Objective To explore the clinical effect of noninvasive ventilator assisted ventilation combined with morphine in the treatment of acute left heart failure. Methods 180 patients with acute left heart failure，who were in hospital from January 2014 to December 2015，were selected as the research object and divided into experimental group and the control group according to random number table method， with 90 cases in each group. The control group patients were given noninvasive ventilator assisted ventilation treatment，and the experimental group patients were treated with morphine on the basis of the control group.The clinical efficacy， adverse reactions and improvement of monitoring indexes of the two groups were observed and compared. Results The total effective rate of the control group was 74.4%，significantly lower than that of the experimental group 90%.The difference between the two groups was statistically significant（P<0.05）.The incidence of adverse reactions in the control group was 35.6%，and there was no significant difference between the groups of 36.7% （P>0.05）.After treatment， the DBP， SBP， HR， RR， BNP and PaCO2 of the experimental group were significantly lower than those of the control group.The PaO2，PaO2/FiO2 of the experimental group were significantly higher than those of the control group， and the differences were statistically significant between the two groups（P<0.05）.After treatment，the APACHE Ⅱ score of the experimental group after treatment was significantly lower than that of the control group，and the difference was statistically significant（P<0.05）. Conclusion noninvasive ventilator assisted ventilation combined with morphine in the treatment of acute left heart failure can effectively improve the symptoms，has significant clinical effect，and does not increase adverse reactions.

[Key words] Noninvasive ventilator；Morphine；Acute left heart failure；Assisted ventilation

近年来，心力衰竭的发生率逐渐升高，急性左心衰竭起病急骤，需及时进行治疗[1]，否则会危及患者的生命。随着医疗科技的发展，无创呼吸机被应用到临床急性左心衰竭的治疗中，目前，有研究显示[2]无创呼吸机辅助通气联合吗啡治疗急性左心衰竭的临床效果较佳，本研究选取本院收治的急性左心衰竭为研究对象，主要探讨无创呼吸机辅助通气联合吗啡治疗急性左心衰竭的临床效果，以期为临床提供参考。

1 资料与方法

1.1 一般资料

选取2014年1月～2015年12月本院收治的180例急性左心衰竭患者为研究对象，所有患者的诊断均符合2014年中国心力衰竭诊断和治疗指南中急性左心衰竭的诊断标……