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OBJECTIVE：To study the efficacy and safety of sacubitril valsartan sodium tablets combined with Bailing capsules in the treatment of chronic left heart failure with renal insufficiency ，and to provide reference for clinical drug use. METHODS ： Totally 96 patients with chronic left heart failure with renal insufficiency who sought medical care in our hospital from Nov. 2018 to Nov. 2019 were divided into group A ，B and C according to table of random numbers ，with 32 cases in each group. Group A received conventional heart failure treatment and and Bailing capsules （2 g each time ，3 times a day ）；group B received conventional heart failure treatment and Sacubitril valsartan sodium tablets （50 mg each time ，twice a day ）；group C was given with heart failure treatment and Sacubitril valsartan sodium tablets （50 mg each time ，twice a day ）and Bailing capsules （2 g each time，3 times a day ）. 3 groups received consecutive 6 months of treatment. Clinical response rates of 3 groups were compared. Left heart function indexes [left ventricular end systolic diameter （LVESD），left ventricular end-diastolic diameter （LVEDD），left ventricular ejection fraction （LVEF）] and serological indexes [interleukin 1（IL-1），IL-6，N terminal brain natriuretic peptide precursor，glomerular filtration rate （GFR）] were detected before and after treatment. The occurrence of ADR were observed and recorded. RESULTS ：During this study ，a total of 6 patients fell off ，and eventually 90 patients completed the study ，including 29 cases in group A ，30 cases in group B and 31 cases in group C. Before treatment ，there was no statistical significance in left heart function indexes or serological indexes among 3 groups（P＞ 0.05）. After 6 months of treatment ，clinical response rate of group C was significantly higher than those of group A and B 163.com （P＜0.05）. Compared with before treatment ， LVEDD， LVESD and serological indexes of 3 groups were decreased significantly after treatment （P＜0.05），while LVEF and GFR were increased significantly （P＜0.05）；the changes of above indexes （except for IL- 1 level in serum ） in group C were significantly better than group A and B ，the changes of above indexes in group B （except for GFR ）were significantly better than group A （P＜0.05）. No significant ADR were observed in 3 groups. CONCLUSIONS ：Sacubitril valsartan sodium tablets combined with Bailing capsules can significantly decrease the level of serum inflammation factors ，and improve cardiac and renal function in patients with chronic left heart failure with renal insufficiency ，with good safety.
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Objective To explore the effect of continuous renal replacement therapy (CRRT) combined with mild hypothermia (MHT) on acute severe heart failure after cardiovascular surgery. Methods A retrospective analysis was performed of 26 patients who were treated from January 2007 to January 2015 with the combined therapy of CRRT and MHT (CRRT/ MHT). Core temperature was reduced to 34 ℃. The doses of inotropes and vasopressors decreased. Mean arterial pressure (MAP) was maintained at 60-70 mmHg and cardiac index (CI) >1.5 L/(min·m2). When cardiac function was improved core temperature was recovered gradually. The dose of inotropes and the volume load increased, and the CRRT was discontinued. Comparison of outcomes was made with a matched historic ECMO control group. The core body temperature, pulmonary arterial wedge pressure, mean arterial pressure, cardiac index, the doses of inotropes and vasopressors, mean arterial pressure and cardiac index were observed and recorded. The time for supportive treatment, successful off-line rate, ICU time and hospital stay, and the survival rate during the ICU and hospital stay were compared between two groups. Results Core body temperature was maintained at (34.0±0.5) ℃ during the combined therapy; Pulmonary arterial wedge pressure, the doses of inotropes and vasopressors, MAP and CI substantially decreased during the combined therapy (P0.05). There were no major complications in CRRT/MHT group. Conclusions These findings suggest that patients with acute severe heart failure after cardiovascular surgery can benefit from a strategy of CRRT/MHT. The results have given us new insight into the treatment of these patients.
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Objective: To investigate the efficacy of sodium creatine phosphate in the treatment of acute left heart failure caused by essential hypertension, and observe the changes of serum cytochrome C (Cyt C) and cardiotrophin-1 (CT-1). Methods: Seventy-three patients with essential hypertension complicated with acute left heart failure were randomly divided into the control group (n=35) and the observation group (n=38). The patients in the control group were given such treatment as oxygen uptake, diuresis, hypotension and dilatation of blood vessels. The patients in the observation group were given sodium creatine phosphate (1. 0mg, ivd, qd) on the basis of the control group. The changes of NYHA functional class, 6-minute walking distance and left ventricular ejection fraction (LVEF% ) before the treatment, 3 days and 7 days after the treatment were observed. The serum levels of NT-proBNP, ST2, Cyt C and CT-1 were measured by ELISA before the treatment and 3 days and 7 days after the treatment. Results: Compared with those be-fore the treatment, the cardiac function indices were improved after the treatment, and the levels of serum NT-proBNP, ST2, Cyt C and CT-1 all decreased (P<0. 05). Conclusion: Creatine sodium phosphate can effectively enhance the clinical efficacy in hypertension patients with acute left heart failure. The mechanism may be related to enhancing the energy metabolism of myocardial cells and reduc-ing cardiomyocyte apoptosis.
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Objective To explore the clinical effect of non-invasive positive pressure ventilation(NPPV)for treatment of acute left heart failure after mitral valve replacement. Methods Sixty patients with acute left heart failure after mitral valve replacement in Xinxiang Central Hospital from April 2009 to August 2017 were selected. The patients were divided into control group and NPPV group,with 30 patients in each group. The patients in the control group were treated with double oxygen ab-sorption (mask and nasal catheter),strong heart,diuresis and dilated blood vessels. Based on the treatment of control group, the patients in NPPV group were treated with NPPV therapy. The plasma N-terminal pro-B-type natriuretic peptide(NT-proB-NP)level of patients in the two groups was monitored by rapid determination of immunofluorescence before treatment and 6,24 hours after treatment. The respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure monitoring of patients in the two groups was monitored before treatment and 2,6 and 24 hours after treatment. Results The total effective rate of patients in the control group and NPPV group was 92. 4％(26 / 28)and 96. 6％(28 / 29)respectively;there was no sig-nificant difference in the total effective rate between the two groups(χ2 = 1. 25,P > 0. 05). There was no significant difference in the plasma NT-proBNP level between the two groups before treatment (P > 0. 05);the level of NT-proBNP at 6,24 h after treatment was significantly lower than that before treatment in the two groups (P < 0. 05);the level of NT-proBNP of patients in the NPPV group was significantly lower than that in the control group at 6,24 h after treatment (P < 0. 05). There was no significant difference in the respiratory frequency,blood oxygen saturation,heart rate and oxygen partial pressure between the two groups before treatment(P > 0. 05). Compared with before treatment,the respiratory frequency and heart rate of patients were decreased and the blood oxygen saturation,oxygen partial pressure were increased at 2,6,24 h after treatment in the two groups (P < 0. 05). There was no significant difference in the oxygen partial pressure between the two groups at 2 h after treat-ment(P > 0. 05);the oxygen partial pressure of patients in the NPPV group was significantly higher than that in the control group at 6,24 h after treatment(P < 0. 05);there was no significant difference in the respiratory frequency,blood oxygen satu-ration and heart rate between the two groups at each time piont after treatment(P > 0. 05). Conclusion NPPV is an effective treatment for acute left heart failure after mitral valve replacement.
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OBJECTIVE:To investigate therapeutic efficacy and safety of leosimendan in the treatment of acute left heart failure (ALHF) and its effects on left ventricular function indexes and serum markers.METHODS:A total of 110 patients with acute left ventricular function selected as research objects from No.251 Hospital of PLA during Jan.2014-Dec.2015,and then were divided into control group (53 cases) and observation group (57 cases) according to random number table.Both groups received routine therapy.Control group was additionally given Dopamine hydrochloride injection or Dobutamine hydrochloride injection as cardiotonic on the basis of routine therapy.Observation group was additionally given Levosimendan injection with initial dose of 10 μg/kg+0.9％ Sodium chloride injection 50 mL,ivgtt (10 min),and then with micro pump infusion at the rate of 0.1 g/(kg· min) for continuous 24 h.Both groups were treated for continuous 7 d.Clinical efficacies of 2 groups were observed,and the levels of left ventricular function indexes (PER,PFR,LVEF,LVSF) level,serum marker (NT-proBNP) and galectin-3 (Gal-3) before and after treatment,the occurrence of ADR was recorded.RESULTS:Two cases were withdrawn from the study due to death (one case in each group).Finally,a total of 108 cases were included,involving 52 cases in control group and 56 cases in observation group.Clinical total response rate of observation group (94.64％) was higher than that of control group (86.54％),but without statistical significance (P＞0.05).Before treatment,there was no statistical significance in left ventricular function indexes or serum markers levels between 2 groups (P＞ 0.05).After treatment,the levels of left ventricular function indexes were improved significantly in 2 groups,and LVEF and LVSF of observation group were significantly higher than those of control group,with statistical significance (P＜0.05).NT-proBNP and Gal-3 of 2 groups were decreased significantly,and the observation group was significantly lower than the control group,with statistical significance (P＜0.05).No obvious ADR was found in 2 groups during treatment.CONCLUSIONS:Leosimendan in the treatment of ALHF have the similor clinical efficacy with dopamine,but helps to strengthen the left heart pump function,reduce heart failure markers levels with good safety.
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Objective To discuss the efficacy and safety of urapidil combined with fructose injection in hypertensive elderly patients with acute heart failure(AHF).Methods Sixty-two elderly patients with acute heart failure complicated with hypertension from cardiovascular medicine of the fifth people's hospital of qinghai province were randomized into urapidil group (n =30)and urapidil combined with fructose treatment group (combined group,n =32).Two groups of patients were given regular heart failure treatment (oxygen,strong heart,diuresis,ACEI,etc),patients in urapidil group were treated with urapidil 50-100μg/min,48 h after continuous dosing,individualized adjust delivery time,dosing time adjustmented as individualized.On the basis of urapidil group,patients in combined group were treated with Fruc-tose-1,6-Diphosphate (FDP) injection of 5.0g,intravenous drip within 10 minutes,the duration was 7 days in two groups.The clinical efficacy was compared in two groups after treatment.Their parameters were compared before and on days 1,2,3 and 7 after treatment.The adverse reactions occur were recorded in patients of two groups during the treatment.Results There was no statistically significant difference in baseline data such as sex ratio,age,etc between the two groups (P ＞ 0.05).The total clinical efficacy rate in combined group was significantly higher than urapidil group(87.50％ vs 73.33％,x2 =6.102,P =0.047).The systolic pressure,diastolic blood pressure and heart rate of each time after treatment were gradually lower than before treatment in the two groups patients.These was no statistical significance difference in blood pressure and heart rate between the two groups at each time point after treatment (P ＞ 0.05).Compared with urapidil group,the left entricular ejection fraction (LVEF) and cardiac index (CI) were rised significantly.The left ventricular end systolic diameter (LVESD) and left ventricular end systolic volume (LVESV) were significantly decreased.The plasma N-terminal brain natriuretic peptide (NT-proBNP) was significantly reduced (P ＜ 0.05) in combined treatment group patients after treatment 7 days.There was no reflectively heart rateaccelerating in combined treatment group.Urapidil combined with fructose showed no bad influence on blood glucose,cholesterol and triglyceride.And combined treatment groups patients had significantly less side effects than their counterparts in urapidil group,but had no obvious statistical significance difference (10.00％ vs 3.13％,x2 =1.213,P =0.321).Conclusion Urapidil combined with fructose injection treatment hypertensive elderly patients with acute left heart failure demonstrated better efficacy and less side effects than urapidil alone on lowering and stabilizing systolic BP,improving cardiac function more significant.
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[Objective] The present study was to evaluate the association of serum total cholesterol level and prognosis in patients with acute left heart failure and associated mechanisms.[Methods] Sixty-eight patients due to acute episode of left heart failure prospectively enrolled,and baseline data and biochemical parameters were collected.After discharge,patients were follow-up for 1 month and they were divided into two groups (with and without cardiovascular events).Differences between groups were evaluated and the association of serum total cholesterol level and cardiovascular events were analyzed by logistic regression analysis.[Results] The mean age was 57.3 ± 12.6 years old and 52 cases were male patients accounting for 76.5 ％.Among these patients,46 had a diagnosis of coronary heart disease (67.6 ％),10 rheumatic heart disease (14.7 ％),12 dilated cardiomyopathy (17.7％),38hypertension (55.9％) and 24 diabetes mellitus (35.3％).After 1 month's follow up,39 patients (57.4％) had experienced cardiovascular events,36 cases were re-hospitalized,and 3 died from heart failure.Compared to those with cardiovascular events,event free individuals were younger and were less likely smokers (P ＜ 0.05).In addition,event free group had lower serum levels of N-terminal pro-BNP and C-reactive protein (P ＜ 0.05) while serum levels of total cholesterol and albumin were significantly higher (P ＜ 0.05).There was no significant difference in medication between these two groups.After adjusted for age,gender,smoking,systolic blood pressure,serum albumin level,diabetes,hypertension and medications,increased total cholesterol level was independently associated with better prognosis with odds ratio of 0.91 (95 ％ confidence interval 0.80-0.96).Further adjusted for C-reactive protein,the association was attenuated to non-significance,with odds ratio of 0.97 (95 ％ confidence interval 0.87-1.09).[Conclusion] Adequate serum total cholesterol level was beneficial for improving short-term cardiovascular outcomes in patients with left heart failure and the potential mechanisms might be related to cholesterol effects on improving nutritional status and anti-inflammation.
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Objective:To evaluate the application values of intraaortic palloon pumping in the treatment of acute left heart failure.Methods:From February 2013 to January 2016,102 patients in our hospital for diagnosis and treatment of acute left heart failure were selected as the research object,all the patients were equally divided into the observation group and control group with 51 patients in each group according to the random draw envelope principle.The control group was given routine drug treatment,the observation group was given intraaortic palloon pumping treatment based on the treatment in control group,the prognosis of two groups were observed and compared between two groups.Results:The total effective rate of observation group and control group were 96.1％ and 84.3 ％,respectively,which was significantly higher in the tobservation group than that of the control group (P＜0.05).The LVEF values in the observation group and control group after treatment were 65.22 ± 4.52 ％ and 58.20 ± 5.31％ respectively,which were significantly higher than those before treatment 45.29± 5.14 ％ and 45.20± 4.89 ％,and the LVEF value of observation group was significantly higher than that of the control group (P＜0.05).After 6 months' treatment,the incidence of death,refractory ischemia,malignant arrhythmia and other recent primary end points in the observation group was 5.9 ％,the control group was 21.6 ％,which was significantly higher than that of the observation group (P＜0.05).Conclusion:Aortic balloon pump implantation could promote the improvement of left ventricular function,improve the treatment effect,reduce the occurrence of recent primary end point event in the treatment of acute left heart failure.
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Objective To study the effects of QRS-complex duration of patients with chronic left heart failure on their in-hospital prognosis. Methods Total 174 patients admitted for chronic left heart failure ( New York Heart Association class 3 and 4 ) from January 2014 to June 2015 were enrolled the study. They were divided into two groups according to the QRS duration at admission:normal QRS duration group (QRS ≤120 ms, n=145) and prolonged QRS group (QRS ﹥120 ms, n=29). The differences of clinical characteristics and incidences of exacerbated left heart failure, fatal arrhythmias and cardiac death during hospitalization were compared between the two groups. The influences of QRS duration on in-hospital adverse cardiovascular events was analyzed by logistic regression. Resu1ts The proportion of males (75. 9% vs. 24. 1%, P=0. 001), plasma B-type natriuretic peptide (BNP) (7. 1 ± 0. 8 vs. 6. 6 ± 1. 0, P=0. 02), left ventricular end diastolic diameter (LVEDd) [(60. 7 ± 9. 9)mm vs. (53. 5 ± 10. 8)mm, P=0.001], left ventricular end systolic diameter (LVESd) [(49.1 ±13.3)mm vs. (39.7 ±13.0)mm, P﹤0. 001], and the incidence of exacerbated left heart failure (20. 7% vs. 4. 8%, P = 0. 003), fatal arrhythmias (55. 2% vs. 21. 4%, P ﹤0. 001) and cardiac death (6. 9% vs. 0. 7%, P =0. 019) during hospitalization were significantly higher in the prolonged QRS group than in the normal QRS group. Left ventricular ejection fraction( LVEF) in the prolonged QRS group was significantly lower than in the normal QRS group (39. 6% ±17. 3% vs. 50. 5% ± 17. 3%, P =0. 002). Heart rates [(92. 4 ± 21. 4)bpm vs. (81. 6 ± 19. 9)bpm,P=0. 035], plasma BNP(7. 2 ± 0. 8 vs. 6. 7 ± 1. 0, P=0. 029), LVEDd(63. 5 ± 9. 1 vs. 57. 9 ± 9. 1, P=0. 015), LVESd (52. 9 ± 12. 2 vs. 44. 3 ± 11. 8, P=0. 005), incidences of left heart failure deterioration (18. 2% vs. 3. 2%, P=0. 018), fatal arrhythmias (63. 6% vs. 36. 5%, P=0. 027) and cardiac death ( 9. 1% vs. 0%, P=0. 015 ) during hospitalization among male patients in the prolonged QRS group were significantly higher than those in the normal QRS group, but LVEF ( 35. 0% ± 15. 3%vs. 47. 1% ± 16. 2%, P =0. 003 ) was on the opposite. The incidence of left heart failure deterioration among female patients in the prolonged QRS group was higher than that in the normal QRS group ( 28. 6%vs. 6. 1%, P=0. 034). QRS complex duration was positively related to LVEDd ( r=0. 4019, P﹤0. 001) and LVESd ( r =0. 3289, P ﹤0. 001 ) . LVEF in male patients was significantly lower than in female patients (40. 0% ± 16. 7% vs. 53. 2% ± 17. 6%, P﹤0. 001). On the contrary, LVEDd [(59. 4 ± 9. 4) mmvs. (50.3±10.6)mm,P﹤0.001],LVESd[(46.6±12.5)mmvs. (36.2±12.4)mm,P﹤0.001] were greater in male patients than in female patients. After adjusting for gender , age, cigarette smoking, history of high blood pressure, serum creatinine, low-density lipoprotein cholesterol, LVEF, LVEDd, LVESd, use of angiotensin converting enzyme inhibitors ( ACEI) or angiotensin receptor blockers ( ARB) and aldosterone receptor blockers, multiple logistic regression analysis showed that prolonged QRS complex duration is an independent risk factor of adverse prognosis for the patients with HF during hospitalization (OR=4. 21,95%CI:1. 59-11. 12,P=0. 004), and female gender is a protective factor for them ( OR=0. 304,95%CI:0. 116-0. 793,P=0. 015). Conc1usions The incidences of left heart failure deterioration, fatal arrhythmias and cardiac death in the chronic left heart failure patients with prolonged QRS duration were higher than in those with normal duration. Female gender is a protective factor for chronic left heart failure.
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Objective To discuss the diagnostic value of N-terminal-pro-brain natriuretic peptide (NT-proBNP) for patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) complicated with left heart failure. Methods Patients with medical history of AECOPD, or are diagnosed as AECOPD from March 2014 to February 2015 were involved in the study. Based on echocardiography and clinic characteristics , the patients were divided into left heart failure group (group A) and non-left heart failure group (group B). Related factors of elevated NT-proBNP in AECOPD and the diagnostic value of NT-proBNP for patients with AECOPD complicated with left heart failure were analyzed , and exclusive and diagnostic cutoff were worked out. Results In this study , 109 AECOPD patients were collected , including 21 patients in group A and 88 patients in group B. Multivariate linear regression analysis indicated NT-proBNP was positively associated with PCT (β=0.180,P = 0.011) and PAP(β = 0.333,P = 0.000), and negatively with LVEF(β = -0.511,P = 0.000)and the area under the ROC curve(AUC) was 0.959 (95% confidence interval:0.915-1.002,P = 0.000). The exclusive cutoff was 794.6 pg/mL(sensitivity:90.5%,specificity:92%), and the diagnostic cutoff 1 618 pg/mL(sensitivity:85.7%,specificity: 97.7%). Conclusions NT-proBNP can help to diagnose whether AECPOD patients are complicated with left heart failure. Besides left heart dysfunction and the state of systemic inflammation , pulmonary hypertension may be the reasons for the elevated NT-proBNP in AECOPD patients.
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Objective To investigate the pH changes of arterial blood in patients with acute left heart failure.Methods Thirty-eight patients with acute left heart failure were selected as our subjects,who all underwent diuresis,the strong heart diuresis,dilation of blood vessels,reducing the load on the heart,and making water and electrolyte balance of conventional medication,and then parallel oxygen mask,respirator mode synchronized intermittent mandatory ventilation(SIMV).If hypoxia was not significantly improved,and positive pressure ventilation with end expiratory(PEEP) treatment was conducted.Results After treatment,the level of pH,heart rate(HR),breathing rate(RR),arterial partial pressure of oxygen(PaO2),arterial partial pressure of carbon dioxide(PaCO2) and mean arterial pressure(MAP) were (7.4 ± 0.3,86.3 ± 6.2) times/min,(22.5 ±4.8) times/min,(84.8 ±7.3) mmHg,(43.3 ±5.5) mmHg,(81.1 ±3.2) mmHg,different from those before treatment(7.1 ±0.1),(118.3 ±8.2) times/min,(36.2 ±7.1) times/min,(47.2 ±6.6) mmHg,(48.3 ±5.2) mmHg,(96.2 ±4.5) mmHg),and the differences were significant (t =5.848,19.188,9.854,23.552,4.072,16.857 respectively; P ＜ 0.01).With the progress of treatment,pH value and pHi value in patients showed a rising trend.Regression analysis showed a positive correlation and the regression equation was Y =-0.559 4 + 1.103 7X.Conclusion Patients with acute left heart failure show abnormal blood pH level and the corresponding change inside red blood cells.Then it causes changes in arterial blood oxygen carrying capacity of red blood cells,reduces the cell through the capillary capacity.Therefore,it can result in decrease of gas exchange levels in patients and hypoxia.Treatment should be considered imbalance the body of the improved state of acid-base.
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Objective To investigate clinical efficacy of different ventilator parameters on acute left heart failure.Methods One hundred and nineteen patients with acute left heart failure were randomly divided into A,B,C,D group.Patients in A,B,C,D groups were treated separately with higher air pressure,high pressure,medium pressure or low pressure respectively.In each group,clinical efficacy,heart rate (HR),arterial partial pressure of oxygen (PaO2),pulse oxygen saturation (SpO2),partial pressure of carbon dioxide (PaCO2) and pH were measured.Results There were significant differences among the four groups in terms of HR,PaO2,SpO2,PaCO2 and pH (F =32.21,29.46,12.34,36.47,18.38 ; P ＜ 0.05).Compared with that in A,C and D group,the levels of HR,PaO2,SpO2,PaCO2 and pH in B group were significant difference (P ＜ 0.05).Meanwhile those indices in B group were difference among before and after treatment (t =12.25,13.46,8.75,9.83,2.58 ;P ＜ 0.05).The efficacy rates of four groups were significant different (x2 =0.97,P =0.012),and in B group was 93.1％,higher than that of other 3 groups(71.0％,65.6％,51.8％ ;P ＜0.05).Condusion The ventilator parameters(10-15 cmH2O,55％-75％ FiO2 at beginning and later revised the FiO2 to 30％-40％) was proved to be worthy in treating acute left heart failure.
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Objective To investigate the effect of noninvasive positive pressure ventilation treatment on patients with acute left heart failure and hyoxemia.Methods Sixty-two patients with acute left heart failure and hyoxemia were divided into control group (31 cases) and treatment group (31 cases).All patients were treated with a conventional therapy plan and patients in treatment were received noninvasive positive pressure ventilation beside conventional therapy.Blood gas analysis,plasma B-type natriuretic peptide (BNP) and clinical manifestation before and after treatment were monitored.Results The time of clinical manifestation al0leviation in treatment group was (33.7 ±7.9) min,shorter than that of control group ((55.9 ± 12.1) min,t =8.554,P ＜0.01).Compared with pre-treatment,heart rate (HR),respiratory rate(RR),mean arterial pressure(MAP),pH,oxygen saturation of blood (SaO2),arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide(PaCO2) and BNP in treatment group were improved significantly(HR:(133.89 ± 5.45) beat/ min vs.(87.27 ± 5.74) beat/min,t =32.794,P ＜ 0.01 ; RR:(34.25 ± 5.67) beat/min vs.(20.15 ± 2.54) beat/min,t =12.636,P ＜ 0.01 ; MAP:(104.52 ± 7.25) mmHg vs.(76.57 ± 3.76) mmHg,t =19.055,P ＜0.01; pH:(7.29±0.06) vs.(7.40 ±0.06),t=7.218,P＜0.01;SaO2:(81.52 ±5.01)％ vs.(97.16±1.27) ％,t =16.848,P ＜ 0.01 ; PaO2:(55.30 ± 7.14) mmHg vs.(92.80 ± 6.24) mmHg,t =22.019,P ＜0.01;PaCO2:(46.23 ±10.30) mmHg vs.(40.56 ±5.19) mmHg,t =2.737,P＜0.05;BNP:(831.59 ±292.65) ng/L vs.(265.52 ±65.39) ng/L,t =10.511,P ＜0.01).And after treatment,HR,RR,MAP,SaO2,PaO2,BNP in control group were improved compared with that before treatment (HR:(132.13 ± 5.31) beat/min vs.(92.15 ± 4.28) beat/min,t =32.638,P ＜ 0.01 ;RR:(34.96 ± 4.78) beat/min vs.(23.91 ± 3.27) beat/min,t=l0.634,P＜0.01;MAP:(102.56 ±7.14) mmHg vs.(82.83±3.52) mmHg,t =13.800,P＜0.01;SaO2:(82.15 ± 5.24) ％ vs.(93.16 ± 2.59) ％,t =10.488,P ＜ 0.01 ; PaO2:(54.56 ± 6.27) mmHg vs.(75.19 ±3.52) mmHg,t =15.974,P ＜0.01 ;BNP:(823.15 ±277.26) ng/L vs.(371.15 ±87.55) ng/L,t =8.656,P ＜0.01).Statistical differences of pH and PaCO2 were not found in the control group before and after treatment(pH:7.32 ± 0.05,t =1.426,P =0.159 ;PaCO2:(43.78 ± 6.74) mmHg,t =0.253,P =0.801).HR,RR,MAP,pH,SaO2,PaO2,PaCO2 and BNP in treatment group were more significantly improved than that of control group(t =3.795,5.056,6.767,5.703,7.721,13.686,2.107 respectively,P ＜ 0.01or P ＜ 0.05).Conclusion The therapy plan of noninvasive positive pressure ventilation on patients with acute left heart failure and hyoxemia can improve cardiac function and oxygenation quickly,and decrease the plasma BNP level.
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Objective To observe the effect of treating acute left heart failure with Shenmai injection and auxiliary conventional western medicine. Methods 132 patients were randomly divided into a control group and a treatment group, with 66 cases in each group. The control group was treated with lanatoside C, captopril, diuretics, and aminophylline. While the treatment group was additionally treated with Shenmai injection on the basis of the control group. Left ventricular ejection fraction(LVEF), left smothering end-diastolic diameter(LVEDD)value, the index of b-type natriuretic peptide(BNP), and 24 h dynamic electrocardiogram(ecg)were observed in both groups after 1 month’s treatment. Results LVEF and BNP were improved in both groups after the treatment[LVEF and BNP were(40.42 ± 4.32)%, (306.57 ± 201.21)pg/ml in the treatment group and(37.92±3.32)%, (451.51±294.23)pg/ml in the control group before the treatment;(35.28±4.15)%, (540.17±382.23)pg/ml in the treatment group and(35.13±2.35)%, (572.35± 422.21)pg/ml in the control group after the treatment], and the curative effect in the treatment group was better than the control group(P0.05). Conclusion Shenmai injection has good effects in the treatment of acute left heart failure.
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Objective To investigate the various occasions of invasive mechanical ventilation in patients with acute left heart failure. Methods Thirty-two patients with acute severe left heart failure were divided into two groups:17 patients were treated with non-invasive mechanical ventilation (non-invasive mechanical ventilation group) and 15 patients were treated with invasive mechanical ventilation (invasive mechanical ventilation group). The respiratory rate (RR), arterial oxy-gen partial pressure p(O2), heart rate (HR) and mean arterial pressure (MAP) were observed after treatment for 0.5 h,1 h and 3 h in two groups of patients. The in-hospital mortality was compared between two groups. Results Ten patients of non-in-vasive mechanical ventilation group were in remission after 0.5 h, 7 cases without remission switched to endotracheal intuba-tion for invasive mechanical. And 3 of them were in remission in 0.5~1 h, 4 of them dead. Fourteen patients in invasive me-chanical ventilation group were in remission after 0.5 h, one case was in remission after 0.5~1 h and no dead in this group. There were more patients in remission after 0.5 h in invasive mechanical ventilation group than those of non-invasive me-chanical ventilation group (P=0.041). There were no significant differences in the number of patients in clinical remission af-ter 0.5~1 h and mortality between two groups. The values of RR and HR were decreased with the increasing treatment time in two groups. The values of p(O2) and MAP were increased with the increasing treatment time in two groups. There was a sig-nificantly lower RR at 0.5 h and 1 h in invasive mechanical ventilation group than that of non-invasive mechanical ventila-tion group (P ＜ 0.05). The values of p(O2) and MAP were significantly higher at 0.5 h in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group (P＜0.05). The levels of HR at 0.5 h and 3 h were significant-ly lower in invasive mechanical ventilation group than those of non-invasive mechanical ventilation group ( P＜0.05). Con-clusion Invasive mechanical ventilation should be used as soon as possible if non-invasive mechanical ventilation can not alleviate the symptoms in patients more than 0.5 hours.
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Objective To investigate the efficacy and security of noninvasive ventilator assisted ventilation combined with morphine in treating acute left heart failure.Methods Sixty patients suffering acute left heart failure were divided into two groups:conventional therapy group (thirty cases using morphine and other medicine) and combined group (thirty cases using noninvasive ventilator assisted ventilation combined with morphine).Observe and record clinical results for blood pressure,heart rate,respiratory rate,blood gas analysis,left ventricular ejection fraction (LVEF) as well as occurrence rate of remission time and adverse reaction before treatment,one hour after treatment and remission respectively.Results Clinical results for blood pressure,heart rate,respiratory rate,blood gas analysis,left ventricular ejection fraction (LVEF) have improved after treatment,all clinical indexs have improved obviously except for partial pressure of carbon dioxide in combined group.The difference was significant (P ＜ 0.05) ; Remission time in combined group (6.20 ± 4.12 hours) was shorter than morphine group (8.67 ± 5.28) hours,which has statistically difference (P ＜ 0.05).But occurrence rate of adverse reaction and complication raised slightly in combined group (43.3％ vs.40％).Conclusions Noninvasive ventilator assisted ventilation combined with morphine can relieve clinical symptoms promptly in acute left heart failure,improve prognosis,it is a effectively and safety therapeutic measures.
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Objective To compare the therapeutic effects in respect of ventilatory response and the change of hemodynamics of two modes of mechanical ventilation [ proportional assist ventilation (PAV) vs.Bi-level positive airway pressure ventilation (BiPAP) ] on patients with acute cardiogenic pulmonary edema (ACPE).Methods Thirty-two patients diagnosed as ACPE were recruited from May 2008 to April 2009.After conventional therapy ( cardiotonic,diuretic,vasodilators,oxygen) were ineffective for half an hour,32 patients were randomly divided into three groups:control group ( 12 cases kept conventional treatment without mechanical ventilation),BiPAP group ( 12 cases were treated with BiPAP mode of non-invasive mechanical ventilation plus conventional treatment) and PAV group (8 cases were treated with PAV mode of non-invasive mechanical ventilation along with conventional treatment ).Results PaO2,RR and oxygenation index were improved significantly in three groups after 1 hour treatment ( P ＜ 0.05 ).While PaO2 and oxygenation index in noninvasive ventilation groups were higher than those in control group ( P ＜0.05 ).The time required for amelioration of dyspnea in noninvsaive ventilation groups was shorter than that in control group ( P ＜ 0.05 ).The peak airway pressure and the index of degree of comfort ( VAS score,auxiliary respiratory muscles score) in PAV group were lower than those in BiPAP group (P ＜ 0.05 ).Conclusions Both modes of noninvasive mechanical ventilations could improve the oxygenation and relief of dyspnea in patients with ACPE.PAV and BiPAP had the similar effect in patients with ACPE.The synchronization and comfort in PAV group were better than those in BiPAP group.The PAV mode of noninvasive mechanical ventilation was well accepted by patients with ACPE.
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ObjectiveTo explore the clinical value of diltiazem in patients with acute left heart failure caused by hypertension and rapid atrial fibrillation. MethodsNinety-nine hospitalized patients with acute left heart failure caused by hypertension and rapid atrial fibrillation were randomly divided into observation group (61 cases) and control group (38 cases). Conventional therapy was given in the two groups and diltiazem was added in observation group. Blood pressure, heart rate and respiration rate was compared.ResultsAfter treatment for 30 min and 1 h, the levels of SBP and DBP were significantly lower in observation group than those in control group (P ＜ 0.01 ). After treatment for 30 min, the rate of dyspnea disappearing,heart rate decreasing below 100 times/min, rale in lung decreasing or disappearing, quiet and sweat disappearing [44.3％ (27/61) ,42.6％ (26/61) ,44.3％ (27/61),41.0％ (25/61)] were significantly higher than those in control group [18.4％(7/38), 15.8％(6/38), 18.4％(7/38), 15.8％(6/38)] (P ＜ 0.01 ). After treatment for 1 h, the levels of above mentioned index were significantly higher than those in control group (P ＜ 0.01 ). ConclusionDiltiazem has exact effect in the treatment of acute left heart failure caused by hypertension and rapid atrial fibrillation, and is valuable in clinic.
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Objective To observe the effect of early non-invasive positive pressure ventilation(NIPPV)on the treatment of serious hypoxemia induced by acute left heart failure. Methods Forty patients with acute left heart failure( Grade Ⅳ heart function)were randomly divided into two groups. Patients in both groups accepted supportive treatment included cardiotonics, diuretics, vasodilators, in additional to these high concentrations of oxygen were given in conventional group, and non-invasive positive pressure ventilation were given in NIPPV group by biphasic positive airway pressure(BiPAP). Systolic blood pressure, heart rate, respiratory rate, blood-gas analysis( pH, PaO2, PaCO2, SaO2 )and clinical signs were observed at 2 hours after treatments. Results Compared to control,RR( [ 19.55 ± 1.88] vs [21.85 ±3.51 ] ) BPM] ,HR ( [96.40 ±2.80] vs[ 103.20 ±6.78 ] BPM), SBP ( [ 116.30 ± 8.95 ] mm Hg vs [ 122.50 ± 6.13 ] mm Hg), pH (7.404 ± 0.027 vs 7.358 ±0.05) ,SaO2 ( [93.57 ± 1.18]% vs [91.97 ± 1.85]% ) ,PaO2 ( [75.58 ±4.61 ]mm Hg vs [68.38 ±7.95]mm Hg), PaCO2 ( [ 38.69 ± 3.06 ] mm Hg vs [ 43.61 ± 2.65 ] mmHg) were significantly different in NIPPV group( t = 2.582,4.146,2.558,3.534,3.256,3.505,5.428, Ps ＜ 0.05 ). We found no significant differences in the comparisons before treatments. Hypoxia improved in NIPPV group,and the total effective rate was 95% in NIPPV group and 70% in control group,which showed significant difference( x2 =4.329 ,P ＜0.05 ) Conclusion BiPAP non-invasive positive pressure ventilation combined with routine treatment in treating heart failure, could promptly correct hypoxia, improve heart function and shortening disease course.
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A 62-year-old man had been given a diagnosis of atrial septal defect (ASD) 20 years previously, but the condition was left untreated. A heart murmur was detected on a routine health examination, so he visited our institution where a diagnosis of type II ASD and moderate tricuspid regurgitation was given. Cardiac catheterization revealed a pulmonary to systemic flow ratio (Qp/Qs) of 2.9, pulmonary vascular resistance of 3.1 units, and systolic pulmonary artery pressure of 90 mmHg. The patient underwent open surgery consisting of a patch closure of the ASD, and tricuspid annuloplasty. His pulmonary arterial pressure rose and his blood pressure dropped, and left cardiac failure developed on postoperative day (POD) 2. The administration of catecholamines and a phosphodiesterase (PDE) III inhibitor failed to correct the left cardiac failure. We performed intra-aortic balloon pumping (IABP) immediately, and his hemodynamic condition stabilized. The IABP catheter was removed on POD 10. The postoperative development of circulatory failure suggested that it was almost too late for surgery for ASD. It has been believed that surgery for ASD is relatively safe. However, it seems that, the considering the possible occurrence of postoperative cardiac failure in elderly patients with accompanying pulmonary hypertension, careful postoperative management is necessary.