The clinical observation on chronic pulmonary illness with cardiac failure and hyperlactacidemia treatmented by bi-level positive airway pressure ventilation
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摘要: 目的：探讨无创双水平正压通气（BiPAP）治疗慢性心肺功能衰竭急性发作致高乳酸血症患者的临床疗效。方法：回顾性分析60例慢性心肺功能衰竭急性发作致高乳酸血症患者的临床资料，根据治疗方案分为常规氧疗组30例（常规组）和BiPAP无创组30例（BiPAP组）。观察入科首日及第3天基本生命体征及临床试验指标，包括血乳酸、pH、pO2、pCO2、NT-proBNP、白细胞总数、肌酐及白蛋白；研究观察截点为5 d内的插管率。结果：2组比较，BiPAP组ICU住院时间更短[（10.5±2.4） d vs.（6.3±2.6） d，t=6.5，P<0.05]，5 d内插管率更低（36.6% vs.13.3%，t=4.35，P<0.05）；可观察到BiPAP组的乳酸明显下降[（1.8±0.4） mmHg vs.（1.2±0.5） mmHg（1 mmHg=0.133 kPa），P<0.05]，最终第 3 天乳酸值低于常规组[（1.5±0.4） mmol/L vs.（2.3±0.4） mmol/L，P<0.05]，同步变化的还有：NT-proBNP的降低程度[（200±21） ng/L vs.（104±21） ng/L]及第3天数值[（216±100） ng/L vs.（354±115） ng/L，P<0.05]；pO2、pCO2的3 d差值低于常规组[（13±7） mmHg vs.（24±15） mmHg]；（18±7） mmHg vs.（26±6） mmHg；P<0.05）。结论：BiPAP能同步治疗慢性肺疾病合并心力衰竭患者的缺氧血症及降低心脏负荷，进而纠正组织缺氧及酸中毒。Abstract: Objective: To evaluate the clinical value of bi-level positive airway pressure ventilation on the treatment of chronic pulmonary illness with cardiac failure and hyperlactacidemia.Method: Respective analysis on the clinical datas from 60 chronic pulmonary cases with cardiac failure from two central ICU in 5 days,patients were divided into control groups with oxygen therapy and invasive ventilationa groups with BiPAP based on the treatment managemence;the characteristics and laboratory indexes including lactic acid,PH,pO2,PCO2,NT-proBNP,total number of white blood cells,Creatinine and Albumin were determinated at day 0,3;the intubation rate at day 5 was the cut point of this research.Result: Compared with control groups,patients in BiPAP groups suffer lower intubation rate (36.6% vs.13.3%,t=4.35,P<0.05) and shorter stay of ICU[(10.5±2.40 d vs.(6.3±2.6) d,t=6.5,P<0.05];From laboratory data in our research,the better outcome in BiPAP groups were accompanied with more rapadily reverse of hyperlactacidemia[(1.8±0.4) mmol/L vs.(1.2±0.5) mmol/L,P<0.05] and lower level of serum lactate at day 3[(1.5±0.4) mmol/L vs.(2.3±0.4) mmol/L,P<0.05],as same as the rapadiliy changes[(200±21) ng/L vs.(104±21) ng/L,P<0.05] and lower vaue[(216±100) ng/L vs.(354±115) ng/L,P<0.05] of NT -proBNP in BiPAP groups at day 3;the decrease of pO2,PCO2 were confirmed in two groups but larger changes were found in BiPAP groups[(13±7) mmHg vs.(24±15) mmHg;(18±7) mmHg vs.(26±6) mmHg;P<0.05].Conclusion: The application of BiPAP could synchronous reversed hyperlactacidemia on chronic pulmonary patients with cardiac failure through correcting hypoxemia and carbon dioxide on retention and decreasing load of heart.
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