中国心血管病研究2024，Vol.22Issue(1) ：54-59.DOI:10.3969/j.issn.1672-5301.2024.01.010

对比BiPAP无创通气与经鼻高流量氧疗治疗不同分级老年急性左心衰竭伴低氧血症的疗效

Comparison of the efficacy of BiPAP non-invasive ventilation and nasal high flow oxygen therapy in the treatment of acute left heart failure with hypoxemia in elderly patients with different grades

费优生 张超 高洁 徐俊蛟 赵成刚
中国心血管病研究2024，Vol.22Issue(1) ：54-59.DOI:10.3969/j.issn.1672-5301.2024.01.010
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对比BiPAP无创通气与经鼻高流量氧疗治疗不同分级老年急性左心衰竭伴低氧血症的疗效

Comparison of the efficacy of BiPAP non-invasive ventilation and nasal high flow oxygen therapy in the treatment of acute left heart failure with hypoxemia in elderly patients with different grades

费优生 1张超 1高洁 1徐俊蛟 1赵成刚1
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作者信息

  • 1. 201802 上海市,上海市嘉定区南翔医院急诊科
  • 折叠

摘要

目的 对比双水平正压(BiPAP)无创通气与经鼻高流量氧疗(HFNC)治疗不同分级老年急性左心衰竭伴低氧血症的疗效.方法 选取2021年6月至2023年5月上海市嘉定区南翔医院急诊科收治的老年急性左心衰竭伴低氧血症患者180例作为研究对象,采用抽签法分为A组和B组,各90例,其中A组患者接受BiPAP无创通气,B组患者接受HFNC治疗.分别于抢救治疗后即刻、后6h、24h采集两组患者静脉血和动脉血,分别测定血清N末端B型利钠肽前体(NT-proBNP)、和肽素(Copeptin)和血气分析,了解各时段NT-proBNP、Copeptin和二氧化碳分压(PaO2)、血氧饱和度(SaO2)的水平,记录两组患者气管插管率及预后的结果.结果 经治疗后,两组患者总有效率均为88.89%,但是B组中Ⅱ级和Ⅲ级患者有效率分别为90.70%、78.95%高于A组89.66%、88.89%,Ⅳ级患者有效率78.95%低于A组87.50%,但差异无统计学意义(P>0.05).两组患者治疗后即刻、后6h、24h时,患者的NT-proBNP水平趋势为Ⅱ级<Ⅲ级<Ⅳ级(P<0.05),而Copeptin在不同分级患者之间整体差异不明显(P>0.05).治疗后24h内,两组患者NT-proBNP和Copeptin水平均降低,且A组中Ⅱ级和Ⅲ级患者NT-proBNP水平[(3561.16±126)pg/ml、(4681.23±245.33)pg/ml]高于B组中Ⅱ级和Ⅲ级患者[(3026.59±145.27)pg/ml、(4126.89±275.46)pg/ml],Ⅳ级患者者NT-proBNP水平低于B组[(5149.56±312.05)pg/ml比(5463.29±345.71)pg/ml,P<0.05],两组患者治疗后即刻、后6h、24h时,患者的PaO2和SaO2水平趋势均为Ⅱ级>Ⅲ级>Ⅳ级,且经治疗后24h内,患者PaO2和SaO2水平均呈上升趋势.B组Ⅳ级患者治疗后24h时PaO2水平低于A组Ⅳ级患者[(74.12±5.95)mmHg比(80.36±5.72)mmHg],Ⅱ级和Ⅲ级患者治疗后6h和24h时SaO2 水平高于A组同级患者(P<0.05).A组中进行插管患者共9例(10.00%),B组中共8例(8.89%),A组死亡3例(3.33%),B组死亡2例(2.22%).两组患者插管率和死亡率之间差异无统计学意义(P>0.05).结论 BiPAP对心功能分级为Ⅳ级的老年急性左心衰竭伴低氧血症患者疗效较好,HFNC对心功能分级为Ⅱ～Ⅲ级患者的疗效更佳.在临床上应该以患者心功能分级为辅助指标,进行治疗方案的选择.

Abstract

Objective To compare the efficacy of biphasic positive airway pressure(BiPAP)non-invasive ventilation and high flow nasal oxygen therapy(HFNC)in the treatment of acute left ventricular failure with hypoxemia in elderly patients with different grades.Methods One hundred and eighty elderly patients with acute left heart failure and hypoxemia admitted to the emergency department of Shanghai Nanxiang Hospitals from June 2021 to May 2023 were selected as the research subjects.They were divided into Group A and Group B with 90 patients each using a lottery method.Group A received BiPAP non-invasive ventilation,and Group B received HFNC treatment.The venous and arterial blood from all the patients were collected immediately,6 hours,and 24 hours after rescue treatment;and the levels of N-terminal B-type natriuretic peptide precursor(NT-proBNP),copeptin,and blood gas analysis were measured,and the tracheal intubation rate and prognosis of the two groups of patients were record.Results After the treatment,the total effective rates of both groups were 88.89%.However,in Group B,the effective rates of Grade Ⅱ and Grade Ⅲ patients were 90.70%and 78.95%,respectively,which were higher than those of 89.66%and 88.89%in Group A and the effective rates of Grade Ⅳ patients were 78.95%lower than that of 87.50%in Group A,but the differences were not statistically significant(P>0.05).At immediate,6 h,and 24 h after treatment,the trend of NT-proBNP levels in the two groups was grade Ⅱ<grade Ⅲ<grade Ⅳ(P<0.05),while the overall difference in copeptin levels among patients of different grades was not significant(P>0.05).Within 24 hours after treatment,the levels of NT proBNP and copeptin in both groups of patients decreased,and the NT-proBNP levels in grade Ⅱ and Ⅲ patients in Group A[(3561.16±126)pg/ml,(4681.23±245.33)pg/ml]were higher than those in grade Ⅱ and Ⅲ patients in group B[(3026.59±145.27)pg/ml,(4126.89±275.46)pg/ml],while the NT-proBNP level in grade Ⅳ in Group A was lower than that in group B[(5149.56±312.05)pg/ml vs.(5463.29±345.71)pg/ml,P<0.05].Immediately after treatment,at the 6 and 24 hours,the levels of PaO2 and SaO2 in all the patients showed a trend of grade Ⅱ>grade Ⅲ>grade Ⅳ.Within 24 hours after treatment,the levels of PaO2 and SaO2 in all the patients showed an upward trend.At 24 hours after treatment,the PaO2 level in Group B's Grade Ⅳ patients was lower than that in Group A's Grade Ⅳ patients[(74.12±5.95)mmHg vs.(80.36±5.72)mmHg].At 6 hours and 24 hours after treatment,the SaO2 levels in Grade Ⅱ and Ⅲ of Group B were higher those that in Group A(P<0.05).A total of 9 patients(10.00%)underwent intubation in Group A,8 patients(8.89%)in Group B;3 patients(3.33%)died in Group A,and 2 patients(2.22%)died in Group B.There was no statistically significant difference in intubation rate and mortality rate between the two groups(P>0.05).Conclusion BiPAP has a better therapeutic effect on elderly patients with acute left heart failure and hypoxemia with cardiac function grading of Ⅳ,while HFNC has a better therapeutic effect on patients with cardiac function grading of Ⅱ and Ⅲ.In clinical practice,the classification of patients'cardiac function should be used as an auxiliary indicator to select treatment options.

关键词

无创通气/经鼻高流量氧疗/急性左心衰竭/低氧血症/和肽素

Key words

Non invasive ventilation/Transnasal high flow oxygen therapy/Acute left heart failure/Hypoxemia/Copeptin

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基金项目

上海市嘉定区自然科学研究基金(JDKW-2021-0045)

出版年

2024
中国心血管病研究
中国医师协会，煤炭总医院

中国心血管病研究

CSTPCD
影响因子：0.878
ISSN：1672-5301
参考文献量25
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