Objective:To compare the clinical effect of early use of noninvasive ventilation and delayed use of noninvasive ventilation in the treatment of acute left heart failure and type Ⅱ respiratory failure.Method:166 patients with the acute left heart failure and type Ⅱ respiratory failure diagnosed and treated in this hospital from June 2013 to May 2015 were divided into the research group and the control group according to the random number table,with 83 cases in each group.Patients in the control group were given the routine treatment and low-flow oxygen.After 1-2 h,in case of no obvious improvement on the respiratory function,the noninvasive ventilation was adopted.In addition to the routine treatment,patients in the research group were given the noninvasive ventilation immediately.The physical signs and blood gas indices before and after the treatment were compared between two groups,as well as the therapeutic effect and length of hospital stay.Result:All patients survived.There were no significant difference in the heart rate,respiration,mean arterial pressure and arterial partial pressure of oxygen before the treatment between two groups(P>0.05),while these four indices for patients both groups were significantly improved after the treatment(P<0.05).The degree of improvement for above indices in the research group were significantly better than those in the control group(P<0.05).The effective rate in the research group was 83.13% and its invasive ventilation rate was 16.87%;the effective rate in the control group was 60.24% and its invasive ventilation rate was 39.74%.The effective rate of noninvasive ventilation in the research group was significantly higher than the one in the control group(P<0.05).Meanwhile,the length of hospital stay for patients in the research group was significantly shorter than that in the control group(P<0.05).Conclusion:The early use of noninvasive ventilation in the treatment of acute left heartfailure and type Ⅱ respiratory failure can rapidly relieve the symptoms and signs,improve the blood gas indices,optimize the hypoxemia,greatly reduce the risk of transfer of invasive ventilation,and then significantly shorten the length of hospital stay.%目的:比较早期应用无创通气和延迟应用无创通气治疗急性左心功能衰竭并Ⅱ型呼吸衰竭疗效.方法:将笔者所在医院2013年6月-2015年5月确诊并收治的166例急性左心衰合并Ⅱ型呼吸衰竭患者.按照随机数字表法分为研究组和对照组,每组83例.对照组给予常规处置及低流量吸氧,1~2 h后呼吸功能改善不明显则给予无创通气.研究组给予常规处置的同时立即给予无创通气.对比两组治疗前后基本体征及血气指标,对比两组疗效及住院时长.结果:全部患者存活.两组治疗前心率、呼吸、平均动脉压及动脉氧分压比较差异无统计学意义(P>0.05),治疗后两组这四项指标均比治疗前显著好转(P<0.05).研究组以上指标好转幅度显著好于对照组(P<0.05).研究组治疗有效率为83.13%,相应其有创通气率为16.87%;对照组有效率为60.24%,有创通气率为39.74%.两组相比研究组无创通气有效率显著高于对照组(P<0.05).同时,研究组住院时间显著短于对照组(P<0.05).结论:早期应用无创通气治疗急性左心衰并Ⅱ型呼吸衰竭可迅速缓解其症状体征,使血气指标恢复地更好,优化低氧血症,且使中转有创通气的风险极大降低,显著缩短住院时间.
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