陈辉,朱少文,邓小琴,赖连娣,邓宏伟
CHEN Hui,ZHU Shaowen,DENG Xiaoqin,LAI Liaodi,DENG Hongwei

• 1:广东省英德市人民医院呼吸内科

摘要(Abstract)：

目的:研究无创正压通气对慢性阻塞性肺疾病急性加重(AECOPD)合并Ⅱ型呼吸衰竭患者血浆N端脑利钠肽前体(NT-pro BNP)水平的影响及临床意义。方法:选取50例AECOPD合并Ⅱ型呼吸衰竭患者作为观察组,另选取同期收治的50例AECOPD未合并呼吸衰竭患者作为对照组,两组患者均接受吸氧、化痰、抗感染、支气管扩张剂、调节酸碱失衡等常规治疗,观察组在常规治疗基础上给予无创正压通气治疗,比较两组患者治疗前、治疗48 h后的血浆NT-pro BNP水平、动脉血气指标(pH、PaO_2、Pa CO2)变化,对所有患者血浆NT-pro BNP水平与动脉血气指标的相关性进行分析。结果:治疗前观察组患者血浆NT-pro BNP、Pa CO2水平高于对照组,pH、PaO_2水平低于对照组,差异有统计学意义(P<0.01);治疗后两组患者血浆NT-pro BNP、Pa CO2水平低于治疗前,且观察组低于对照组(P<0.05),PaO_2水平均高于治疗前,且观察组高于对照组(P<0.01);对照组患者治疗前后pH水平比较,差异无统计学意义(P>0.05);治疗后观察组患者pH水平高于治疗前,但低于对照组,差异有统计学意义(P<0.05);所有患者的血浆NT-pro BNP浓度与Pa CO2水平呈正相关(P<0.05),与pH、PaO_2值呈负相关(P<0.05)。结论:AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-pro BNP表达高于单纯AECOPD患者,采用无创正压通气治疗能降低血浆NT-pro BNP表达,能为临床评估患者病情严重程度与预后、制定诊疗方案提供参考。
Objective: To study the effect and clinical significance of non-invasive positive pressure ventilation( NIPPV) on plasma N-terminal pro-brain natriuretic peptide( NT-pro BNP) levels of patients with acute exacerbation of chronic obstructive pulmonary diseases( AECOPD) combined with typeⅡrespiratory failure. Methods: Fifty patients with AECOPD combined with typeⅡrespiratory failure were selected as observation group,and 50 AECOPD patients without respiratory failure were selected as control group at the same time. Two groups received routine treatment as oxygen inhalation,expectorant,anti infection,bronchodilator and regulation of acid-base imbalance. Based on the routine therapy,observation group was given NIPPV. The changes of plasma NT-pro BNP level,arterial blood gas indexes( pH value,PaO_2,Pa CO2) of two groups before treatment and after treatment for 48 h were compared. The correlation between plasma NT-pro BNP level and arterial blood gas indexes of allpatients was analyzed. Results: Before treatment,the plasma NT-pro BNP,Pa CO2 levels of observation group were higher than those of control group,and pH,PaO_2 levels were lower than control group( P <0. 01); After treatment,the plasma NT-pro BNP,Pa CO2 levels of two groups were lower than those before treatment,and observation group was lower than control group,the PaO_2 level of two groups was higher than that before treatment,and observation group was higher than control group( P < 0. 01);There was no statistical difference in the pH level in control group before and after treatment( P > 0.05); After treatment,the pH level of observation group was higher than that before treatment,but it was lower than that of control group( P < 0. 05); The plasma NT-pro BNP concentration of all patients was positively correlated with Pa CO2level( P < 0. 05),and was negatively correlated with pH,PaO_2( P < 0. 05). Conclusion: The plasma NT-pro BNP expression of patients with AECOPD combined with typeⅡrespiratory failure is higher than that of AECOPD patients. NIPPV can decrease plasma NTpro BNP expression,provide reference for clinical evaluation of patients' diseases and prognosis,formulating diagnosis and treatment regimen.

关键词(KeyWords)： 肺疾病,慢性阻塞性;无创正压通气;血气分析;Ⅱ型呼吸衰竭;血浆;N端脑利钠肽前体
pulmonary diseases;chronic obstructive;non-invasive positive pressure ventilation;blood gas analysis;type Ⅱ respiratory failure;plasma;N-terminal pro-brain natriuretic peptide

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 陈辉,朱少文,邓小琴,赖连娣,邓宏伟
CHEN Hui,ZHU Shaowen,DENG Xiaoqin,LAI Liaodi,DENG Hongwei

DOI: 10.19367/j.cnki.1000-2707.2017.06.025

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