经有创通气与无创通气治疗的心源性休克患者临床特征与预后研究

doi:10.3969/j.issn.1002-1949.2018.11.009

Chinese Journal of Critical Care Medicine

2018, Vol. 38

Issue (11): 964-969 DOI: 10.3969/j.issn.1002-1949.2018.11.009

Clinical characteristics and prognosis of the patients with cardiogenic shock treated with invasive ventilation and non-invasive ventilation

Li Yu-dong, Yang Qing-quan, Mao Shao-fen, Zhang Ming-lei, Wang Xing, Zhan Fei-fei

First Special Ward, Nanyang City Central Hospital, Nanyang 473000, China

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Abstract Objective To analyze the clinical characteristics and prognosis of the patients with cardiogenic shock (CS) treated with invasive ventilation and non-invasive ventilation. Methods 386 CS patients admitted to ICU Department of Cardiology in our hospital were included. The patients were divided into three groups according to the different modes of ventilation in ICU after 24 h: invasive mechanical ventilation group (n=241), non-invasive mechanical ventilation group (n=52) and oxygen supplementation group (n=93). The clinical characteristics, treatment and prognosis of the patients treated with invasive ventilation and non-invasive ventilation were evaluated. Results The invasive ventilation group was more prone to delirium［200 (83.0%) vs. 16 (30.8%), χ2=60.199, P<0.001］, higher lactic acid in arterial blood［3.9 (2.4, 7.1) mmol/L vs. 1.9 (1.6, 2.8) mmol/L, U=13.700, P<0.001］and more severe metabolic acidosis (lower HCO-3)［19.7 (15.8, 21.6) mmol/L vs. 22.1 (20.6, 24.1) mmol/L, U=3.134, P=0.002］. It suggests that there are serious tissue hypoperfusion and shock in patients receiving invasive mechanical ventilation. The patients in the non-invasive mechanical ventilation group had higher N-terminal prohormone of brain natriuretic peptide［7376.8 (2054.6, 17373.7) pg/mL vs. 2368.3 (558.2, 8564.7) pg/mL, U=2.261, P=0.023］, suggesting that patients with non-invasive mechanical ventilation may have ventricular dilatation and increased filling pressure. There was no significant difference in cumulative 90-day mortality between two groups (Log rank P=0.163). Multivariate Logistic regression analysis showed that the independent factors associated with 90-day mortality were delirium, coronary artery bypass grafting, acute coronary syndrome, arterial lactate and partial pressure of oxygen in arterial blood (all P<0.05). Ventilation was not associated with 90-day mortality (P=0.856). Conclusion The patients with CS can safely use non-invasive mechanical ventilation to treat patients with respiratory failure. The different ventilation methods were not related to the prognosis of the patients.

About author:: Li Yu-dong, E - mail: dyfhzh@163.com

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	Li Yu-dong
	Yang Qing-quan
	Mao Shao-fen
	Zhang Ming-lei
	Wang Xing
	Zhan Fei-fei

Cite this article:

Li Yu-dong,Yang Qing-quan,Mao Shao-fen, et al. Clinical characteristics and prognosis of the patients with cardiogenic shock treated with invasive ventilation and non-invasive ventilation[J]. Chinese Journal of Critical Care Medicine, 2018, 38(11): 964-969.

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http://www.cnemergency.org.cn/EN/10.3969/j.issn.1002-1949.2018.11.009 OR http://www.cnemergency.org.cn/EN/Y2018/V38/I11/964

［1］王妍, 李碧澄, 杨爽, 等. 急性心肌梗死后心源性休克患者的治疗［J］.中国急救医学, 2016, 36 (4): 371-375.  ［2］Harjola VP, Lassus J, Sionis A, et al. Clinical picture and risk prediction of short-term mortality in cardiogenic shock［J］. Eur J Heart Fail, 2015, 17(5): 501-509. ［3］Silva J, Gonalves L, Sousa PP. Fluid therapy and shock: an integrative literature review［J］. Br J Nurs, 2018, 27(8): 449-454. ［4］中国医师协会心脏重症专家委员会. 低心排血量综合征中国专家共识［J］. 解放军医学杂志, 2017, 4(11): 933-944. ［5］张松. 心源性休克诊治进展及指南解读［J］. 医学研究杂志, 2017, 46(10): 1-3,17. ［6］McMaster KS, Chatterjee T, McBrayer D, et al. Thrombolytic use in the region around Amarillo, Texas, in patients with ST elevation myocardial infarction［J］. Proc (Bayl Univ Med Cent), 2018, 31(1): 9-11. ［7］Erta FS, Tokgozoglu L, EPICOR Study Group. Long-term follow-up of antithrombotic management patterns in acute coronary syndrome patients［J］. Turk Kardiyol Dern Ars, 2018, 46(3): 175-183. ［8］Spinar J, Parenica J, Vitovec J, et al. Baseline characteristics and hospital mortality in the Acute Heart Failure Database (AHEAD) Main registry［J］. Crit Care, 2011, 15(6): R291. ［9］Puymirat E, Fagon JY, Aegerter P, et al. Cardiogenic shock in intensive care units: evolution of prevalence, patient profile, management and outcomes, 1997-2012［J］. Eur J Heart Fail, 2017, 19(2): 192-200. ［10］刘宏伟, 吴雪萍, 赵晓宁, 等. 主动脉球囊反搏及联合机械通气治疗心源性休克的比较［J］.中华保健医学杂志, 2016, 18(3):196-199. ［11］Aissaoui N, Puymirat E, Juilliere Y, et al. Fifteen-year trends in the management of cardiogenic shock and associated 1-year mortality in elderly patients with acute myocardial infarction: the FAST-MI programme［J］. Eur J Heart Fail, 2016, 18(9): 1144-1152. ［12］Fernandez-Zamora MD, Gordillo-Brenes A, Banderas-Bravo E, et al. Prolonged mechanical ventilation as a predictor of mortality after cardiac surgery［J］. Respir Care, 2018, 63(5): 550-557. ［13］Castillo Costa Y, Mauro VM, García Aurelio M, et al. Cardiogenic shock with ST-segment elevation acute coronary syndrome (ReNa-Shock ST)［J］. Medicina (B Aires), 2017, 77(4): 261-266. ［14］Ruiz-Bailén M, Cobo-Molinos J, Castillo-Rivera AM, et al. Increasing levels of positive end-expiratory pressure improve the left ventricular strain［J］. J Thorac Imaging, 2017, 32(5): 333-339. ［15］Thille AW, Contou D, Fragnoli C, et al. Non-invasive ventilation for acute hypoxemic respiratory failure: intubation rate and risk factors［J］. Crit Care, 2013, 17(6): R269. ［16］Parenica J, Jarkovsky J, Malaska J, et al. Infectious complications and immune/inflammatory response in cardiogenic shock patients: a prospective observational study［J］. Shock, 2017, 47(2): 165-174. ［17］Pirracchio R, Resche Rigon M, Mebazaa A, et al. Continuous positive airway pressure (CPAP) may not reduce short-term mortality in cardiogenic pulmonary edema: a propensity-based analysis［J］. J Card Fail, 2013, 19(2): 108-116.