中华灾害救援医学

目的 探讨无创正压通气(NIPPV)辅助治疗对重症急性心力衰竭(AHF)并发呼吸衰竭(RF)患者临床疗效、心功能、血清学及血气指标的影响。方法 选取2022年1月至2024年12月收治的52例重症AHF并发RF患者，按随机数字表法分为对照组(26例)与研究组(26例)。对照组接受常规药物治疗(利尿、扩血管、强心等)及氧疗，研究组在对照组基础上联用NIPPV。比较两组治疗7d后的临床疗效、心脏指数(CI)、左心室射血分数(LVEF)、左心室舒张末期内径(LVEDd)、左心室收缩末期内径(LVEDs)以及血清N末端B型利钠肽原(NT-proBNP)、C反应蛋白(CRP)、心肌肌钙蛋白I(cTnI)、肌酸激酶同工酶(CK-MB)和血气指标[氧合指数(OI)、动脉血氧分压(PaO₂)、血氧饱和度(SpO₂)、二氧化碳分压(PaCO₂)]的变化。结果 治疗前，两组患者心功能、血清学及血气各项指标差异均无统计学意义(P>0.05)。治疗后，研究组心功能指标EF、CI高于对照组，LVEDs、LVEDd低于对照组(P<0.05)。研究组血气指标OI、PaO₂、SpO₂高于对照组，PaCO₂低于对照组(P<0.05)。研究组血清学指标NT-proBNP、CRP、cTnI、CK-MB均低于对照组(P<0.001)。研究组临床总有效率显著高于对照组(96.15%vs. 69.23%,P=0.028)。结论 在常规药物治疗基础上，联用NIPPV能更有效地改善重症AHF并发RF患者的临床症状，显著提升心功能，降低心肌损伤及炎症标志物水平，并快速纠正低氧血症与二氧化碳潴留，临床疗效确切。

Objective To investigate the effects of non-invasive positive pressure ventilation(NIPPV) as an adjunctive therapy on clinical efficacy, cardiac function, serological markers, and blood gas parameters in patients with severe acute heart failure(AHF) complicated by respiratory failure(RF). Methods Fifty-two patients with severe AHF complicated by RF admitted between January 2022 and December 2024 were selected and randomly divided into a control group(n=26) and a study group(n=26) using a random number table. The control group received conventional drug therapy(diuretics, vasodilators, inotropes, etc.) and oxygen therapy. The study group received NIPPV in addition to the control group's treatment. After 7 days of treatment, clinical efficacy, cardiac index(CI), left ventricular ejection fraction(LVEF), left ventricular end-diastolic dimension(LVEDd), left ventricular end-systolic dimension(LVEDs), serum levels of N-terminal pro-B-type natriuretic peptide(NT-proBNP), C-reactive protein(CRP), cardiac troponin I(cTnI), creatine kinase-MB(CK-MB), and blood gas parameters[oxygenation index(OI), arterial partial pressure of oxygen(PaO₂), oxygen saturation(SpO₂), partial pressure of carbon dioxide(PaCO₂)]were compared between the two groups. Results Before treatment, there were no statistically significant differences in cardiac function, serological, or blood gas parameters between the two groups(P>0.05). After treatment, the study group had higher LVEF and CI, and lower LVEDs and LVEDd than the control group(P<0.05). The study group had higher OI, PaO₂, and SpO₂, and lower PaCO₂ than the control group(P<0.05). The study group had lower serum levels of NT-proBNP, CRP, cTnI, and CK-MB than the control group(P<0.001). The total clinical effective rate was significantly higher in the study group than in the control group(96.15% vs. 69.23%, P=0.028). Conclusion On the basis of conventional drug therapy, the combined use of NIPPV can more effectively improve clinical symptoms, significantly enhance cardiac function, reduce levels of myocardial injury and inflammatory markers, and rapidly correct hypoxemia and carbon dioxide retention in patients with severe AHF complicated by RF, demonstrating definite clinical efficacy.