FMV对肺心病并发呼吸衰竭患者BNP和ET-1水平的影响

目的评价面罩机械通气（facial mask ventilation,FMV）在慢性肺心病伴呼吸衰竭治疗中的临床价值及其治疗前后血浆脑钠素（brain natriuretic peptide,BNP）和内皮素-1（endothelin-1,ET-1）水平的变化。方法慢性肺心病伴呼吸衰竭患者60例,随机分为FMV治疗组（30例）和常规治疗组（30例）。常规治疗组为静脉滴注呼吸兴奋剂、降肺动脉压、强心、利尿剂等药物并加用鼻导管给氧治疗。FMV治疗组,在常规内科治疗同时加用FMV治疗,分别观察治疗72 h后2组患者心率（HR）、呼吸频率（RR）、血压、脉搏、血氧饱和度、血气分析和临床症状、体征以及血浆BNP和ET的变化。结果与常规治疗组比较,FMV组治疗72 h后,患者临床症状与体征的改善明显,其SaO2、PaO2显著升高、PaCO2、HR、RR显著下降（P〈0.05或P〈0.01）。FMV治疗72 h后血浆BNP和ET-1水平随缺氧的改善、二氧化碳潴留的纠正而显著降低（P〈0.01）,与PaO2呈显著负相关（P〈0.01）,与PaCO2呈显著正相关（P〈0.05）。结论FMV在改善慢性肺心病呼吸衰竭患者通气功能的同时,也降低患者血浆BNP和ET-1水平,FMV对慢性肺心病呼吸衰竭患者神经内分泌的影响可能在治疗过程中发挥一定作用。

Effect of facial mask ventilation treatment on plasma concentration of BNP and ET-1 in cor pulmonale patients with respiratory failure

Objective To investigate the curative effects of facial mask ventilation （FMV） treatment on cot pulmonale patients complicated with respiratory failure and the influence of FMV on plasma brain natriuretic peptide （BNP） and endothelin-1 （ET-1）. Methods Sixty patients with cor pulmonale complicated with respiratory failure were randomly divided into treatment group and control group. Patients in control group （30 cases） were treated by routine therapy including respiratory stimulant, reduction of pulmonary artery pressure, cediland, diuretics combined with nasal pipe with oxygen while patients in treatment group （30 cases） were treated by routine therapy combined with FMV. Heart rate （HR）, respiratory rate （RR）, blood pressure, pulse, saturation of blood oxygen, blood-gas analysis and clinical signs were observed after 72 h of treatment. The concentrations of plasma BNP and ET-1 were also measured at the beginning and 72 h later. Results The clinical symptoms and signs improved significantly, while SaO2 and PaO2 elevated and PaCO2, RR and HR reduced significantly （ P 〈 0.05 or P 〈 0.01 ） in FMV group than those in routine therapy group. The plasma levels of BNP and ET-1 were significantly decreased after treatment in both groups, especially in the treatment group （P 〈 0.01 ）. The plasma levels of BNP and ET-1 had significantly negative correlation with PaO2 （ P 〈 0.01 ） and positive correlation with PaCO2 （ P 〈 0.05 ）. Conclusion FMV can improve hypoxemia and CO2 retention and decrease the level of BNP and ET-1 in patients with cor pulmonale complicated with respiratory failure. The influence of FMV on nervous-endocrine may play an important role in treating cor pulmonale patients with respiratory failure.