机械通气治疗急性心肌梗死合并急性左心衰32例临床观察

Effect of Mechanical Ventilation in Treating Acute Myocardial Infarction Combined with Acute Left Heart Failure in 32 Patients

关键词:  急性心肌梗死合并急性左心衰  机械通气  临床观察

Key words:  acute myocardial infarction(AMI) combined with acute left heart failure  mechanical ventilation

摘要:

[目的] 探讨机械通气治疗急性心肌梗死合并急性左心衰的方法。[方法] 32例急性心肌梗死合并急性左心衰患者在常规药物治疗的基础上,使用伟康Esprit、PB-840型呼吸机予以机械通气。分别采用口鼻面罩(24例)、紧急经口气管插管(8例)机械通气治疗。选择压力支持+呼气末正压(PSV+PEEP)、同步间歇指令+压力支持(SIMV+PSV)、压力控制(PCV)等通气模式。[结果] 全部患者在实施机械通气2h后肺部啰音明显减少或消失?玻?后复查血气分析,结果显示全部患者均有不同程度的好转。有效纠正心衰平均4h。有4例患者终因心源性休克不能纠正而死亡。[结论] 结果表明,使用机械通气治疗能够迅速改善急性心肌梗死合并急性左心衰导致的症状,改善肺顺应性,纠正通气/血流比值,避免重要脏器的不可逆损害,可以提高抢救成功率。使用口鼻面罩无创正压机械通气(NPPV)方式经面罩辅助通气方式还具有并发症少、撤机方便的优点。是抢救急性心肌梗死合并急性左心衰的有效措施。

Abstract:

[Objective] To discuss the possibility of mechanical ventilation in treating patients with acute myocardial infarction(AMI) combined with acute left heart failure.[Methods] Thirty two patients with acute myocardial infarction(AMI) combined with acute left heart failure were treated with mechanical ventilation of Esprit and PB-840 type of respiratory machine on the basis of routine medicine treatment. They were manipulated with mechanical ventilation,through nose-oral mask(24cases) and insertion of a tracheal catheter orally(8cases). The ventilate mode of pressure support and positive end-expiratory pressure(PSV and PEEP),synchronized intermittent mandatory ventilation and pressure support(SIMV and PSV),pressure control(PCV) were adopted.[Results] The lung rale was obviously reduced or disappeared two hours after the mechanical ventilation. The gas analysis examined two hours later showed some improvements with different degree in all the patients. The patients had different extent improvement on blood gas analysis results. The average time was four hours for correcting heart failure. Four patients died with irreversible cardiac shock.[Conclusions] The treatment of mechanical ventilation was an effective measures for treating patients with acute myocardial infarction(AMI) combined with acute left heart failure. It may improve the clinical symptoms and lung compliance,correct the ratio of ventilation and blood flow,avoid the occurrence of the irreversible injury of the important organs and enhance the achievement ratio of rescuer work in patients with AMI combined with acute left heart failure.