本文選題：嗎啡 + 無(wú)創(chuàng)正壓機(jī)械通氣��； 參考：《青島大學(xué)》2013年碩士論文

【摘要】：目的 觀察嗎啡鎮(zhèn)靜提高無(wú)創(chuàng)正壓機(jī)械通氣治療急性左心衰患者的臨床效果,為臨床經(jīng)驗(yàn)性治療提供依據(jù)。 方法 選擇2011年9月—2012年6月入住我院的急性左心衰竭病人32例,其中男19例,女13例。將32例急性左心衰竭病人隨機(jī)分為嗎啡組和對(duì)照組各16例,對(duì)照組給予常規(guī)利尿、強(qiáng)心和無(wú)創(chuàng)正壓通氣治療。嗎啡組在對(duì)照組治療的基礎(chǔ)上持續(xù)靜脈輸注嗎啡(5ug. kg-1. h-1)。無(wú)創(chuàng)正壓通氣設(shè)置；持續(xù)氣道正壓+壓力支持模式(CPAP+PS模式),壓力支持(PS)8cmH2O,呼氣末壓力(PEEP)由4cmH2O開始逐漸增加至6cmH2O,吸氧濃度(Fi02)30%～60%,通過調(diào)節(jié)吸入氧濃度維持目標(biāo)值SpO2＞90%。呼吸監(jiān)測(cè)每次分別自主吸呼氣量和分鐘通氣量。對(duì)照組使用機(jī)械通氣記錄使用期間上述指標(biāo)的變化。嗎啡組在使用機(jī)械通氣前首先靜脈注射嗎啡3mg,繼以5ug·kg-1·h-1恒速靜脈泵入,應(yīng)用統(tǒng)計(jì)學(xué)方法比較兩組間治療前后24小時(shí)患者生命體征、機(jī)械通氣效果、動(dòng)脈血?dú)夥治觥⒑粑h(huán)功能及血清BNP的變化。 結(jié)果 1、嗎啡組治療30min后,患者的心率、呼吸頻率均有改善(P＜0.05),動(dòng)脈血?dú)夥治鲲@示PaO：明顯增加,PaCO2明顯下降,pH值恢復(fù)正常(P＜0.05～0.01),治療24h后血清BNP明顯下降,氧合指數(shù)、尿量明顯升高,心功能評(píng)分均明顯改善(P＜0.01)。 2、對(duì)照組治療30min后心率、呼吸頻率及動(dòng)脈血?dú)庵笜?biāo)輕度改善(P＜0.05),治療24h后血清BNP輕度下降,氧合指數(shù)及尿量輕度升高,心功能評(píng)分輕度改善。 3、嗎啡組治療30min后心率、呼吸頻率、動(dòng)脈血?dú)庵笜?biāo)、心肌耗氧指標(biāo)改善均優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(t=2.32～16.29,P＜0.05～0.01)。嗎啡組治療24h后血清BNP、氧合指數(shù)、尿量及心功能改善均優(yōu)于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(t=7.82～15.34,P＜0.01)。 4、BNP作為心衰的生物標(biāo)志物,對(duì)急性左心衰竭診斷和鑒別診斷有肯定的價(jià)值,急性左心衰患者血清BNP水平顯著升高,兩組在治療前血清BNP水平差異無(wú)統(tǒng)計(jì)學(xué)意義(P＞0.05),治療24h后,治療組血清BNP水平顯著低于對(duì)照組(P＜0.01)。 5、嗎啡組治療30min后16例患者胸悶及呼吸困難顯著緩解,肺部Up音顯著減少甚至消失,機(jī)械通氣適應(yīng)度和通氣效果明顯優(yōu)于對(duì)照組,且無(wú)不良反應(yīng)。對(duì)照組治療30min后13例患者病情有所緩解,2例患者因病情需行氣管插管機(jī)械通氣,1例患者因并發(fā)嚴(yán)重心律失常死亡。 結(jié)論 嗎啡不僅有良好的鎮(zhèn)靜和改善心功能的效果而且能提高機(jī)械通氣效率,并無(wú)不良反應(yīng),對(duì)于急性左心衰竭病人,在常規(guī)治療的基礎(chǔ)上建議運(yùn)用無(wú)創(chuàng)正壓機(jī)械通氣聯(lián)合嗎啡進(jìn)行治療,這樣能夠迅速糾正低氧血癥,緩解急性左心衰竭病人的臨床癥狀,是臨床一種有效的治療方法。
[Abstract]:Purpose To observe the clinical effect of morphine sedation in the treatment of acute left heart failure by non-invasive positive pressure mechanical ventilation. Method Thirty-two patients with acute left ventricular failure admitted to our hospital from September 2011 to June 2012 were selected, including 19 males and 13 females. 32 patients with acute left ventricular failure were randomly divided into morphine group (n = 16) and control group (n = 16). The control group was treated with routine diuretic, cardiac strengthening and noninvasive positive pressure ventilation. In morphine group, 5 渭 g 路kg -1 路h -1 of morphine was continuously infused intravenously on the basis of treatment in the control group. Continuous positive airway pressure (CPAP PS mode), pressure support (PS8 cm H 2O), end expiratory pressure (PEEP) gradually increased from 4cmH2O to 6cm H 2O, oxygen concentration (Fi02C 3030) was increased to 6cm H 2O, and the target value SpO2 > 90 was maintained by adjusting the oxygen concentration of inhaled oxygen. Breath monitoring was performed on each time with spontaneous expiratory volume and minute ventilation volume, respectively. The changes of the above indexes during the use of mechanical ventilation were recorded in the control group. Before using mechanical ventilation, morphine 3 mg was injected intravenously in morphine group, followed by intravenous infusion of 5ug kg-1 h-1 at constant velocity. The vital signs, mechanical ventilation effect and arterial blood gas analysis were compared between the two groups before and after 24 hours of treatment. Changes of respiratory and circulatory function and serum BNP. Result 1. After treatment with 30min, the heart rate and respiratory rate of morphine group were improved (P < 0.05). Arterial blood gas analysis showed that Pao: Pao: Pao: Pao: Pao: Paco _ 2 decreased significantly and pH value returned to normal (P < 0.05). After 24 hours of treatment, serum BNP decreased significantly, oxygenation index and urine volume increased significantly. Cardiac function scores were significantly improved (P < 0.01). 2. In the control group, the heart rate, respiratory rate and arterial blood gas index were slightly improved after treatment with 30min (P < 0.05). After 24 hours of treatment, the serum BNP decreased slightly, the oxygenation index and urine volume increased slightly, and the cardiac function score was slightly improved. 3. The improvement of heart rate, respiratory rate, arterial blood gas index and myocardial oxygen consumption index in morphine group was better than that in control group after treatment with 30min. The difference was statistically significant (P < 0.05). The improvement of serum BNP, oxygenation index, urine volume and cardiac function in morphine group was better than that in control group 24 hours after treatment, and the difference was statistically significant (P < 0.01). 4BNP, as a biomarker of heart failure, has positive value in the diagnosis and differential diagnosis of acute left heart failure. The serum BNP level in patients with acute left heart failure was significantly increased. There was no significant difference in serum BNP levels between the two groups before treatment (P > 0.05). 24 hours after treatment, there was no significant difference in serum BNP levels between the two groups. The serum BNP level in the treatment group was significantly lower than that in the control group (P < 0.01). 5. In morphine group, chest tightness and dyspnea in 16 patients with 30min were significantly alleviated, but lung up tone was decreased or even disappeared. Mechanical ventilation fitness and ventilation effect were significantly better than those in control group, and there was no adverse reaction. In the control group, 13 patients had remission after 30min, 2 patients needed mechanical ventilation with endotracheal intubation, 1 patient died of severe arrhythmia. Conclusion Morphine not only has good sedation and heart function improvement effect, but also can improve the mechanical ventilation efficiency, there is no adverse reaction, in patients with acute left heart failure, On the basis of routine treatment, it is suggested that non-invasive positive pressure ventilation combined with morphine should be used to correct hypoxemia rapidly and relieve the clinical symptoms of patients with acute left heart failure. It is an effective clinical treatment method.
【學(xué)位授予單位】：青島大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2013
【分類號(hào)】：R541.6

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相關(guān)期刊論文 前10條

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