Effect Of Early Application Of Noninvasive Positive Pressure Ventilation In Acute Left Heart Failure

ObjectiveThe purpose of this study is to explore the positive role of noninvasive positive pressure ventilation in the adjuvant treatment of acute left ventricular failure with clinical comparative data.By establishing a model,we compare the difference and prognosis between the conventional drug treatment group（control group）and the noninvasive positive pressure ventilation treatment group（treatment group）in the treatment of acute left ventricular failure.Through statistical data,we can get a more reasonable time for clinical intervention.So as to alleviate the pain of patients,reduce the rate of endotracheal intubation,improve the prognosis,shorten the days of hospitalization,and guide clinical practice,increase the success rate of clinical treatment..MethodsAccording to the diagnostic criteria of Chinese Heart Failure Diagnosis and Treatment Guidelines 2014 and NYHA Cardiac Function Classification（Fig.1）,18 patients with acute left heart failure were selected from CCU and ICU in our hospital from January 2018to December 2018.The total number of patients with NYHA Cardiac Function Classification（NYHA Cardiac Function Classification）was 36.They were divided into two groups,18 patients in CCU routine drug treatment group（control group）.)Eighteen patients in ICU group and non-invasive positive pressure ventilation group（treatment group）.The changes of clinical symptoms,respiratory rate（RR）,heart rate（HR）,partial pressure of oxygen（Pa O ₂）,oxygen saturation（SPO ₂）,N-terminal pro-brain natriuretic peptide（NT-pro BNP）and cardiac output（CO）were compared between the two groups after treatment.The difference of total effective rate and average hospitalization days between the two groups was compared.Curative effect evaluation（1）Significant effect:Cyanosis disappeared 1 hour after treatment,palpitation,shortness of breath and dyspnea were relieved,heart rate,rhythm,blood pressure and breathing were restored to normal,pulmonary beep was reduced or disappeared,and arterial blood gas Pa O ₂>60 mm Hg.（2）Effective:Cyanosis and dyspnea were alleviated 1 hour after treatment,and respiratory,heart rate,blood pressure,Sa O ₂or Pa O ₂ were improved.（3）Invalidity:If clinical symptoms do not improve or even aggravate,consciousness disorder and blood gas deteriorate（PAO ₂<55 mm Hg,Sa O ₂<85%in peripheral blood and PH value in arterial blood decrease to<7.2）,then immediate tracheal intubation is replaced by invasive positive pressure ventilation.Cardiac arrest or irregular spontaneous breathing rhythm,apnea or irregular breathing,are ineffective treatment.Results（1）There were no significant differences in gender,body mass index（BMI）,age and basic heart disease between the two groups（P>0.05）.（2）Before treatment,there were no significant differences in respiratory rate（RR）,heart rate（HR）,oxygen saturation（SPO ₂）,partial pressure of oxygen（Pa O ₂）,N-terminal pro-brain natriuretic peptide（NT-pro BNP）,cardiac output（CO）between the two groups（P>0.05）.However,after 1 and 6 hours of treatment,the oxygen partial pressure,oxygen saturation,heart rate and respiratory rate of the non-invasive positive pressure ventilation group increased significantly,and the oxygen partial pressure and oxygen saturation of the conventional treatment group increased,while the heart rate and respiratory rate decreased.However,after treatment,the clinical symptoms of the non-invasive positive pressure ventilation group improved more significantly than that of the conventional treatment group.After 48 hours,the N-terminal procephalic sodium was measured again.There were also differences in NT-pro BNP and cardiac output（CO）,with statistical significance（P<0.05）.（3）One case in the non-invasive positive pressure ventilation group needed endotracheal intubation,while five cases in the conventional group.There was a significant difference in the rate of endotracheal intubation between the two groups.The difference was significant（P<0.05）.（4）After 18 cases of routine treatment group,13 cases were effective,the total effective rate was 72.2%,18 cases of non-invasive positive pressure ventilation group,17cases were effective,the total effective rate was 94.4%（P<0.05）.（5）Noninvasive positive pressure ventilation group and routine treatment group had no death cases.16 patients in noninvasive positive pressure ventilation group were followed up for 48 hours,and 2 patients were successfully withdrawn after 72 hour.ConclusionEarly non-invasive positive pressure ventilation in patients with acute left heart failure can quickly relieve the pain of patients,significantly improve left ventricular function,improve the total effective rate of treatment,improve prognosis,shorten hospitalization days,which is worthy of further promotion.