老年急性心肌梗死合并急性左心衰竭和呼吸衰竭患者的机械通气治疗.docVIP

老年急性心肌梗死合并急性左心衰竭和呼吸衰竭患者的机械通气治疗 作者：范利 贾国栋 史扬 高德伟 李小鹰 作者单位：解放军总医院南楼临床部，北京 100853 【摘要】 目的 探讨老年急性心肌梗死合并急性左心衰竭和呼吸衰竭患者应用机械通气治疗的临床经验。方法 总结83例入选患者应用机械通气治疗的方式、病情好转率与病死率，并对未采用呼吸终末正压通气(PEEP)支持(组)和采用PEEP支持(组)的两组患者资料进行比较。结果 与治疗前比较，治疗后2 h和24 h时两组pH值、PaO2、PaO2/FiO2均明显改善(P 005)，并且组的PaO2/FiO2改善更显著(P 005);组和组病情好转率分别为527%和711%(两组比较P 005)，病死率分别为473%和378%(两组比较P 005)，均明显低于文献报道。结论 及早提供机械通气并用PEEP支持治疗对改善老年急性心肌梗死合并急性左心衰竭和呼吸衰竭的病情是非常重要的。 【关键词】 老年人;急性心肌梗死;急性左心衰竭;急性呼吸衰竭;机械通气;呼气终末正压通气 Mechanical ventilation therapy for aged patients with acute myocardial infarction complicating acute left heart failure and respiratory failure FAN Li, JIA GuoDong, SHI Yang, et al Clinical Department of Southern Building, General Hospital of PLA, Beijing 100853, China 【Abstract】 Objective To discuss the clinical experience of mechanical ventilation in treatment of aged patients with acute myocardial infarction (AMI) complicating acute left heart failure and acute respiratory failure.Methods The pattern, improvement rate and mortality of 83 patients treated by mechanism ventilation, were divided into group Ⅰ〔control mechanical ventilation (CMV) alone〕 and group 〔CMV + positive endexpiratory pressure (PEEP)〕, were retrospectively analyzed.Results After 2 and 24 h of treatment, the pH, PaO2 and PaO2/FiO2 ratio were significantly increased in the two groups compared those before treatment (P 0.05). The PaO2/FiO2 ratio was significantly higher in the group Ⅱ than that in the group Ⅰ(P 0.05), and the improvement rate was also significantly higher in the group Ⅱ than that in the group Ⅰ(71.1% vs 52.7%, P 0.05). Moreover, the mortality rate in group Ⅰand Ⅱwas 47.3% and 37.8% respectively (P 0.05), being lower than that in review reported.Conclusions Early and effective mechanical ventilation with PEEP is essential management for patients with AMI complicating acute left heart failure and acute respiratory failure. 【Key words】 Senile; Acute myocardial infarction; Acute left heart failure; Acute respi