机械通气治疗急性心肌梗死并急性呼吸衰竭的临床研究

摘要

目的 探讨急性心肌梗死(AMI)合并急性呼吸衰竭患者应用机械通气治疗的临床疗效.方法 回顾性分析2003年9月至2010年10月应用机械通气治疗50例AMI合并急性呼吸衰竭患者的临床资料,观察治疗前后所有患者呼吸频率(RR)、心率(HR)、pH值、动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)、射血分数(EF)和心功能分级.结果治疗后44例存活者由原来的心功能Ⅳ级改善到心功能Ⅰ～Ⅱ级,RR、HR显著减慢,pH值、PaO2、PaCO2、EF均明显改善.治疗后30 min、2h、4h的RR、HR、PaO2、PaCO2、EF分别为[(30.2±8.1)次/min、(21.8±6.9)次/min、(18.8±8.5)次/min],[(121.8±6.9)次/min、(105.3±8.2)次/min、(87.8±3.7)次/min],[(60.1±5.9)mmHg(1 mmHg=0.133 kPa)、(69.9±10.8) mmHg、(79.2±8.9) mmHg],[(44.9±4.4) mmHg、(40.1±3.3) mmHg、(39.8±3.5) mmHg],[(30.3±4.7)、(35.3±4.6)、(42.1±3.7)]；与治疗前比较,差异有统计学意义(P＜0.05).结论 机械通气对改善AMI并急性呼吸衰竭的病情是非常重要的.%Objective To discuss the efficacy of mechanical ventilation in the treatment of acute myocardial infarction (AMI) complicated with acute respiratory failure (ARF). Methods The clinical data of 50 patients with AMI complicated with ARF treated by mechanical ventilation, admitted in our hospital from September 2003 to October 2010, were retrospectively studied. The changes of respiratory rate (RR), heart rate (HR), pH, PaO2, PaCO2, ejection fraction (EF), cardiac function before and after treatment were compared. Results 44 of the SO patients survived. In the 44 cases, cardiac function was improved from Killip class IV to I ～ II, RR and HR were decreased, pH, PaO2 and EF were significantly increased and PaCO2 were significantly decreased. At 30 min, 2 h and 24 h after treatment, RR were (30.2±8.1) times/min, (21.8±6.9) times/min, (18.8±8.5) times/min, respectively. HR were (121.8±6.9) times/min, (105.3±8.2) times/min, (87.8±3.7) times/min, respectively. PaO2 were (60.1±5.9) mmHg (1 mmHg=0.133 kPa), (69.9± 10.8) mmHg, (79.2±8.9) mmHg, respectively. PaCO2 were (44.9±4.4) mmHg, (40.1±3.3) mmHg, (39.8±3.5) mmHg, respectively. EF were (30.3±4.7), (35.3±4.6), (42.1±3.7), respectively. There were statistically significant difference before and after treatment (P<0.05). Conclusion Mechanical ventilation is of great importance for treating patients with AMI complicated with acute respiratory failure.