不同镇静药物对无创正压通气心力衰竭患者血流动力学 及血气分析影响临床研究.

Objective To observe the effects of different sedatives on hemodynamics and blood gas analysis in patients with heart failure with noninvasive positive pressure ventilation (NPPV) .Methods A total of 90 patients with heart failure diagnosed and treated with NPPV in this hospital from January 2020 to January 2022 were selected as research objects, and randomly divided into groups A,B and C, with 30 patients in each group.The group A was given dexmedetomidine, the group B was given midazolam, and the group C was given propofol. The NPPV time, ICU treatment time, endotracheal intubation rate, mortality within 28 days, incidence of adverse reactions, central venous pressure (CVP),changes of heart rate (HR),N-terminal B-type natriuretic peptide (Nt-proBNP),mean arterial pressure (MAP),arterial oxygen partial oxygen saturation (SpO2),and arterial partial carbon dioxide pressure (PaCO2) at 6,24 and 48 hours after sedation were observed and recorded in each group. Results The NIPPV time, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal in the group A were significantly shorter than those in groups B and C, the differences were statistically significant (P<0.05),but there were no statistical significances in NIPPV time, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal between groups B and C (P>0.05) .The levels of HR, CVP, Nt-proBNP and MAP in group A were significantly lower than those in groups B and C at 6,24 and 48 hours after sedation, the differences were statistically significant (P<0.05) .However, there were no statistical significances in the levels of HR, CVP, Nt-proBNP and MAP between groups B and C at 6,24 and 48 hours after sedation (P>0.05) .SpO2,PaO2 in the group A were significantly higher than those in groups B and C at 6,24 and 48 hours after sedation, and PaCO2 was significantly lower than those in groups B and C, the differences were statistically significant (P<0.05),but there were no statistical significances in SpO2,PaO2 and PaCO2 between groups B and C at 6,24 and 48 hours after sedation (P>0.05) .There was no significant difference in the incidence of complications between the group A (16.67%),group B (26.67%) and group C (30.00%) (P>0.05) .Conclusion Dexmedetomidine, midazolam and propofol have the same incidence of adverse reactions during sedation in patients with NPPV heart failure, but dexmedetomidine is more effective in reducing the duration of NPPV, endotracheal intubation rate, ICU treatment time and wake time after drug withdrawal, and can improve hemodynamic status and cardiac function faster, and correct hypoxemia more significantly. [ABSTRACT FROM AUTHOR]