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目的探讨无创机械通气联合床旁持续血液净化治疗难治性终末期心力衰竭的临床疗效。方法选取2013年1月—2015年6月苏州明基医院收治的难治性终末期心力衰竭患者164例,采用随机数字表法分为对照组和观察组,各82例。对照组患者在常规治疗基础上进行无创机械通气治疗,观察组患者在常规治疗基础上进行无创机械通气联合床旁持续血液净化治疗。比较两组患者疾病相关指标、治疗有效率及生存率。结果治疗前两组患者血清N末端B型脑钠肽(NT-pro BNP)、血肌酐(SCr)水平及动脉血氧分压(Pa O2)比较,差异无统计学意义(P>0.05);治疗后观察组患者血清NT-pro BNP、SCr水平低于对照组,Pa O2高于对照组(P<0.05);治疗后两组患者血清NT-pro BNP、SCr水平均低于治疗前,Pa O2均高于治疗前(P<0.05)。观察组患者心功能治疗有效率、症状体征治疗有效率、生存率高于对照组(P<0.05)。结论无创机械通气联合床旁持续血液净化治疗难治性终末期心力衰竭的临床疗效确切,能有效缓解患者的临床症状,提高治疗有效率和生存率。
Objective To investigate the clinical efficacy of noninvasive mechanical ventilation combined with bedside continuous blood purification in the treatment of refractory end-stage heart failure. Methods 164 patients with refractory end-stage heart failure admitted to BenQ Hospital of Suzhou from January 2013 to June 2015 were randomly divided into control group and observation group with 82 cases in each group. Patients in the control group were treated with non-invasive mechanical ventilation on the basis of conventional treatment. Patients in the observation group were treated with noninvasive mechanical ventilation and bedside continuous blood purification on the basis of routine treatment. The disease-related indicators, treatment efficiency and survival rate were compared between the two groups. Results There was no significant difference in serum N-terminal pro-brain natriuretic peptide (BNP), serum creatinine (SCr) and arterial oxygen tension (Pa O2) between the two groups before treatment (P> 0.05). After treatment, the levels of serum NT-pro BNP and SCr in the observation group were lower than those in the control group, Pa O2 was higher than that in the control group (P <0.05); After treatment, the levels of serum NT-pro BNP and SCr in both groups were lower than those before treatment O2 were higher than before treatment (P <0.05). The effective rate of cardiac function therapy, the effective rate of treatment of symptoms and signs, and the survival rate of observation group were higher than those of the control group (P <0.05). Conclusions Noninvasive mechanical ventilation combined with bedside continuous blood purification in the treatment of refractory end-stage heart failure has definite curative effect, which can effectively relieve the clinical symptoms and improve the treatment efficiency and survival rate.