本文選題：家庭無創(chuàng)正壓通氣 + 慢性左心衰竭��； 參考：《河北醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:慢性左心衰由多種心臟疾病逐漸進展到嚴重的階段出現(xiàn)的,患病人數(shù)多,死亡率高,具有復(fù)雜的臨床癥狀。有效防治慢性左心衰的方法是醫(yī)務(wù)人員不斷探索的。最初慢性左心衰的治療是以改善血流動力學(xué)為主,隨著臨床經(jīng)驗的積累及臨床治療的進展,開始發(fā)展到拮抗神經(jīng)-內(nèi)分泌方面的治療,從而延緩了慢性左心衰的進展速度,有效的降低了該病的死亡率。最近幾年,越來越多的醫(yī)務(wù)工作者開始研究非藥物治療慢性左心衰的方法并付諸實踐。于是,家庭無創(chuàng)通氣作為治療慢性左心衰的方法之一逐漸浮出水面。呼吸系統(tǒng)和循環(huán)系統(tǒng)之間是相互作用與影響的,無創(chuàng)通氣可以通過改善呼吸功能而改善心臟功能,基于上述理論,無創(chuàng)通氣在慢性左心衰治療中起到了不可替代的作用。本研究通過探討家庭無創(chuàng)正壓通氣在慢性左心衰中的治療效果,體現(xiàn)無創(chuàng)通氣在慢性左心衰的應(yīng)用價值。從而為慢性左心衰患者的治療增加一種更為方便、可靠的方法,提高患者生存率,改善其生活質(zhì)量。方法:1病例選擇:選擇就診于保定市第一醫(yī)院的慢性左心衰患者31例,于2016年1月-2016年12月進行觀察。其中男18例,女13例,年齡61-75歲,平均年齡69.37歲。入選標準:(1)所有病例均符合慢性左心衰的診斷標準;(2)依據(jù)紐約心臟病協(xié)會(NYHA)的評價標準,所有患者心功能分級屬于III級-IV級;(3)患者自愿參加本研究。排除標準:(1)培訓(xùn)后,仍不能正確使用無創(chuàng)呼吸機者;(2)面部有手術(shù)、創(chuàng)傷或者畸形,不能滿意佩戴面罩者;(3)因合并青光眼、血壓控制差、胃腸脹氣不易緩解而不能進行無創(chuàng)通氣者;(4)除外右心衰及全心衰者。2通氣治療:將患者分為對照組和治療組,對照組給予常規(guī)抗心衰藥物治療,治療組在常規(guī)藥物治療的基礎(chǔ)上,加用雙水平氣道正壓通氣(BiPAP)的無創(chuàng)呼吸機。參數(shù)設(shè)置:模式為自主呼吸/時間控制自動切換(S/T),初始呼氣壓(EPAP)4cm H20(1cmH20=0.098KPa),逐漸增加至4-8cmH20;初始吸氣壓(IPAP)8cmH20,間隔時間大于5-10min后再逐漸增加(每次2cmH20),直到患者癥狀好轉(zhuǎn)。根據(jù)患者的末梢血氧飽和度調(diào)節(jié)吸氧流量,以維持末梢血氧飽和度波動于90%以上。要求患者間斷應(yīng)用NPPV,每次使用的持續(xù)時間約2h左右。盡量保證患者進餐、交談等個人活動。根據(jù)患者病情及對呼吸機的耐受情況決定每個患者具體的應(yīng)用時間,但每天應(yīng)用呼吸機總的治療時間應(yīng)大于8h。依據(jù)患者病情及呼吸機使用情況,不定期電話或上門隨訪患者一般情況及呼吸機使用過程中的問題,確�；颊卟∏榉�(wěn)定及呼吸機正常使用。3終點觀察指標:患者住院、插管或死亡。4觀察指標:觀察治療1年后患者的臨床癥狀、動脈血氧分壓、6分鐘步行試驗、腦鈉肽、左室射血分數(shù)。5統(tǒng)計方法:應(yīng)用SPSS13.0軟件包進行統(tǒng)計學(xué)分析。計量資料以均數(shù)±標準差表示,治療前后比較采用t檢驗,以P0.05認為統(tǒng)計學(xué)上有顯著性差異。結(jié)果:1治療組15例患者均能配合完成HNPPV治療,對無創(chuàng)通氣耐受良好,依從性好。治療1年后:PaO2,對照組56.32±3.75mmHg,治療組69.52±2.71mmHg,較對照組明顯升高,兩組比較統(tǒng)計上有顯著性差異(P0.05);6MWT,對照組243.42±50.13m,治療組302.72±60.23m,較對照組明顯增加,兩組比較統(tǒng)計上有顯著性差異(P0.05);BNP,對照組421.42±30.78pg/mL,治療組235.72±28.52pg/mL,較對照組明顯下降,兩組比較統(tǒng)計上有顯著性差異(P0.05);左室射血分數(shù),對照組40.25±9.79%,治療組48.89±10.11%,較對照組明顯升高,兩組比較統(tǒng)計上有顯著性差異(P0.05);2治療期間治療組無失訪者,對照組失訪1例,失訪原因為死亡。結(jié)論:長期家庭無創(chuàng)正壓通氣治療可以改善患者臨床癥狀、PaO2、6MWT、BNP、LVEF,從而改善其心功能。
[Abstract]:Objective: chronic left heart failure is progressing from a variety of heart diseases to a serious stage. The number of patients, the high mortality, and the complicated clinical symptoms. The method of effective prevention and treatment of chronic left heart failure is the medical staff to explore. The initial treatment of chronic left heart failure is to improve the hemodynamics, with the accumulation of clinical experience. And the progress of clinical treatment began to develop to antagonistic neuroendocrine therapy, which slowed down the speed of chronic left heart failure and effectively reduced the mortality of the disease. In recent years, more and more medical workers began to study the methods of non drug treatment for chronic left heart failure and put it into practice. One of the ways to treat chronic left heart failure gradually emerges. There is interaction and influence between the respiratory system and the circulatory system. Noninvasive ventilation can improve the function of the heart by improving the respiratory function. Based on the above theory, noninvasive ventilation plays an irreplaceable role in the treatment of chronic left heart failure. This study is based on the study of the family. The therapeutic effect of noninvasive positive pressure ventilation in chronic left heart failure reflects the application value of noninvasive ventilation in chronic left heart failure. Thus, a more convenient and reliable method for the treatment of chronic left heart failure is added to improve the survival rate and improve the quality of life. Method: 1 cases selection: choose the chronic Baoding First Hospital 31 patients with left heart failure were observed in December -2016 January 2016. Among them, 18 men, 13 women, 61-75 years old and 69.37 years old. (1) all cases were in accordance with the criteria for diagnosis of chronic left heart failure; (2) according to the evaluation criteria of the New York Heart Association (NYHA), all patients' cardiac function classification was grade III -IV; (3) patients self We would like to take part in this study. (1) after training, the non invasive ventilator is still not used correctly; (2) the face has surgery, trauma or deformity and can not be satisfied with the mask; (3) the patients with glaucoma, poor blood pressure control, and flatulence are not easy to relieve without non-invasive ventilation; (4) except for right heart failure and heart failure.2 ventilation treatment: will suffer The control group was divided into the control group and the treatment group. The control group was given the conventional anti heart failure drug treatment. On the basis of the conventional drug treatment, the treatment group was added to the noninvasive ventilator with double level positive airway pressure ventilation (BiPAP). The parameters were set: the mode was automatic breathing / time control automatic switching (S/T), and the initial air pressure (EPAP) 4cm H20 (1cmH20=0.098KPa) increased gradually. To 4-8cmH20; initial suction pressure (IPAP) 8cmH20, the interval time is more than 5-10min and then gradually increase (2cmH20), until the patient's symptoms improve. According to the patient's end of oxygen saturation to adjust the oxygen flow, to maintain the end of oxygen saturation of more than 90%. Require patients to discontinuous use of NPPV, the duration of each use about 2H. Quantity ensures the patient's meal, conversation and other personal activities. Depending on the patient's condition and the endurance of the ventilator, the patient's application time is determined, but the daily use of the ventilator should be more than 8h. based on the condition of the patient and the use of the ventilator, the general situation of the irregular telephone or the follow-up patients and the use of the ventilator. The problems in the course were to ensure the stability of the patient's condition and the normal use of the.3 end point of the ventilator: Patients hospitalization, intubation or death.4 observation index: the clinical symptoms, arterial oxygen pressure, 6 minute walking test, brain natriuretic peptide, left ventricular ejection fraction.5 statistical method after 1 years of treatment: statistical analysis with SPSS13.0 software package. T test was used before and after treatment. The results showed that there were significant differences between the 15 patients in the 1 treatment group. The results showed that 15 patients in the 1 treatment group were able to cooperate with the treatment of non invasive ventilation with good compliance and good compliance. After 1 years of treatment, PaO2, the control group was 56.32 + 3.75mmHg, and the treatment group was 69.52 + 2.71mmHg, obviously more than the control group. The two groups were statistically significant differences (P0.05); 6MWT, the control group was 243.42 + 50.13m, the treatment group was 302.72 + 60.23m, the comparison group was significantly increased, the two groups were statistically significant differences (P0.05), BNP, the control group 421.42 + 30.78pg/mL, 235.72 + 28.52pg/mL in the treatment group, compared with the control group, the two groups were statistically significant. The difference (P0.05), left ventricular ejection fraction, 40.25 + 9.79% in the control group, 48.89 + 10.11% in the treatment group, significantly higher in the control group than in the control group (P0.05); the treatment group in the 2 treatment group had no loss of visits, the control group lost 1 cases and the cause of the loss was death. Shape, PaO2,6MWT, BNP, LVEF, so as to improve their heart function.
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R541.6

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