目的 探讨大剂量西地兰联合小剂量酒石酸美托洛尔经静脉途径治疗急性左心衰伴快速心室率心房颤动的疗效与安全性。 方法 将2005年6月-2012年2月收治的76例急性左心衰伴快速心室率心房颤动患者,随机分配至对照组(39例)与治疗组(37例),对照组静脉注射西地兰,治疗组静脉注射西地兰与小剂量酒石酸美托洛尔,分别在用药开始时及用药开始后全程监测收缩压、心室率、呼吸频率、手指脉搏血氧饱和度(SpO2)、呼吸困难程度、肺部啰音与治疗2 h时尿量,记录急性左心衰改善时间。 结果 两组患者在治疗开始时心室率(P=0.246)、呼吸频率(P=0.390)、收缩压(P=0.525)与SpO2(P=0.482)均无统计学意义;在治疗整个过程中,两组患者收缩压与治疗2 h尿量均无统计学意义(P=0.264);在治疗开始后30、60、90、120 min时治疗组患者心室率均显著低于对照组(P=0.000)。治疗组患者从在治疗开始到急性左心衰改善的时间明显短于对照组(P=0.003)。试验期间无1例患者出现病情恶化或死亡。 结论 在排除美托洛尔禁忌症的前提下,在严密监测肺部啰音及指氧饱和度的情况下,对那些平时心功能Ⅰ~Ⅱ级的急性左心衰伴快速心室率心房颤动患者,在经静脉途径给予大剂量西地兰的同时,间断多次静脉注射小剂量美托洛尔,能安全有效地控制过快心室率,缩短急性左心衰竭持续时间。
目的 评价重症急性左心衰竭患者机械通气时采用咪达唑仑与吗啡联合持续镇静的效果。 方法 选择2007年4月-2010年4月在重症医学科(ICU)进行有创机械通气的重症急性左心衰竭患者86例,随机均分为咪达唑仑组(A组)、咪达唑仑联合吗啡组(B组)。采用Ramsay镇静评分,使每例患者镇静水平达RamsayⅢ~Ⅳ级。观察起效时间、镇静时间、停药后苏醒时间和停药后拔管时间;监测镇静12 h后的血气分析及血流动力学参数的变化。 结果 B组起效时间、镇静时间、停药后苏醒时间和停药后拔管时间明显短于A组(P<0.05)。且镇静12 h后B组血气分析及血流动力学较A组明显改善(P<0.05)。 结论 重症急性左心衰竭患者机械通气时使用咪达唑仑联合吗啡镇静能达到满意镇静效果,同时改善重症急性左心衰竭患者的低氧血症和高碳酸血症。
目的:分析探讨终末期慢性肾衰竭(CRF)并急性左心衰的发病机制及救治措施。方法:对36例各种原因所致的终末期CRF患者并急性左心衰采用药物控制血压,降低外周血管阻力,减轻心脏后负荷及采用血液透析等方法,减轻心脏前负荷,控制心衰。结果:36例患者2286次来院救治并发急性左心衰1144次,抢救成功1138次,成功率99.5%。结论:终末期CRF并急性左心衰据发病机理不同,给予不同处理,关键是尽快控制血压,脱水,降低外周血管阻力和控制血容量,降低心输出量。
Objective To investigate the effects of noninvasive positive pressure ventilation (NPPV) on patients with acute left heart failure. Methods Twenty patients with acute left heart failure diagnosed between September 2013 and July 2014 were randomized into treatment group (n=10) and control group (n=10). Both groups used conventional sedations, diuretics and drugs that strengthened the heart and dilated the vessels, while early use of NPPV was applied in the experimental group. Arterial blood gas analysis [pH value, pressure of arterial carbon dioxide (PaCO2), and pressure of arterial oxygen (PaO2)], heart rate (HR), respiration, duration of Intensive Care Unit (ICU) stay and invasive mechanical ventilation, duration of overall mechanical ventilation, and success case numbers before and two hours after treatment were observed and analyzed. Results For the control group, two hours after treatment, PaO2 was (67.0±8.5) mm Hg (1 mm Hg=0.133 kPa), HR was (124±10) times/min, Respiration was (34±4) times/min, the duration of ICU stay was (6.0±1.1) days, invasive ventilation was for (32.0±3.1) hours, and the total time of mechanical ventilation was (32.0±3.1) hours. Those indexes for the treatment group two hours after treatment were: PaO2, (82.3±8.9) mm Hg; HR, (98±11) times/min; respiration, (24±4) times/min; the duration of ICU stay, (4.0±0.8) days; invasive ventilation time, (16.0±1.3) hours; the total time of mechanical ventilation, (26.0±1.8) hours. All the differences for each index between the two groups were statistically significant (P < 0.05). Conclusion Early application of NPPV can rapidly relieve clinical symptoms and reduce the medical cost for patients with acute left heart failure.