无创机械通气对老年肺心病伴呼吸衰竭患者血浆脑钠素和内皮素-1水平的影响

目的 评价无创机械通气(NMV)在老年人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(BNP)和内皮素-1(ET-1)水平的变化. 方法 老年慢性肺心病伴呼吸衰竭患者80例,分为NMV治疗组(40例)和常规治疗组(40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.NMV治疗组则在常规内科治疗同时加用NMV治疗,观察治疗72 h后两组患者心率、呼吸频率、血压、脉搏、血氧饱和度(SaO2)、血气分析指标和临床症状、体征及血浆BNP和ET-1的变化. 结果 与常规治疗组比较.NMV组治疗72 h后,患者临床症状与体征的改善明显,其SaO2、氧分压(PaO2)显著升高,二氧化碳分压(PaCO2)、心率、呼吸频率显著下降(t=2.23～3.92,P<0.05或P<0.01).NMV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(t=2.93、3.56.均为P<0.01),与PaO2呈显著负相关(r=-0.69、-0.61,均P<0.01),与PaCO2呈显著正相关(r=0.51、0.42,均P<0.05).结论 NMV在改善老年慢性肺心病伴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,NMV对老年慢性肺心病伴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.

The effect of noninvasive mechanical ventilation treatment on plasma concentration of brain natriuretic peptide and endothelin-1 in senile patients with cor puimonale complicated with respiratory failure

Objective To investigate the curative effect of noninvasive mechanical ventilation (NMV) and its influence on plasma brain natriuretic peptide (BNP) and endothelin-1 (ET-1) in senile patients with cot pulmonale complicated with respiratory failure. Methods Eighty senile patients with cot pulmonale complicated with respiratory failure were randomly divided into treatment group (40 cases) and control group (40 cases). The treatment group was treated by NMV combined with routine therapy, and the control group was treated by only routine therapy including respiratory stimulant,lowering pulmonary artery pressure, cardiotonic agents, diuretics and nasal catheter oxygen inhalation. Blood pressure, heart rate (HR), respiratory rate (RR), blood gas analysis (pH, PaO2, PaCO2 ,SaO2) and clinical symptoms and signs were observed before and 72 hours after treatment. The plasma levels of BNP and ET-1 were also measured before and after treatment. Results Compared with the control group, the clinical symptoms and signs were significantly improved, SaO2 and PaO2 were significantly elevated, and PaCO2, HR and RR were significantly reduced in NMV group (t=2.23 ～ 3.92, P< 0.05 or P< 0.01). The plasma levels of BNP and ET-1 were significantly decreased after treatment in both groups,especially in the treatment group (t=2. 93,3. 56, P<0.01). The plasma levels of BNP and ET-1 had significantly negative correlation with PaO2 (r=-0.69,-0.61 ,P<0. 01) ,and positive correlation with PaCO2 (r= 0.51,0.42, P<0. 05). Conclusions NMV can improve hypoxemia and CO2 retention in senile patients with cot pulmonale complicated with respiratory failure,and may have some influences on neuroendocrine functions.