无创通气对老年重度心力衰竭患者血浆脑钠素、内皮素-1和血管紧张素II水平的影响

探讨老年重度心力衰竭时血浆脑钠素（brain natriuretic peptide，BNP）、内皮素-1（endothelin—1，ET-1）和血管紧张素II（angiotensin II，AngII）水平的变化及无创通气（non—invasive ventilation，NIV）对其影响。老年重度心力衰竭患者42例，随机分为无创通气（NIV）治疗组（21例）和常规治疗组（21例）。常规治疗组为强心、利尿剂、血管扩张剂等药物并加用鼻导管给氧治疗；NIV治疗组为在常规治疗同时加用NIV治疗，分别观察治疗3～5天后两组患者临床症状、体征、心率（HR）、呼吸频率（RR）、血压、血气分析和左室射血分数（left vertricular ejection fraction，LVEF），以及血浆BNP、ET-1和AngII的变化。结果显示，与常规治疗组比较，NIV组治疗3～5天后，患者临床症状与体征改善明显，其SaO2、PaO2和LVEF显著升高（P〈0．05），HR、RR显著下降（P〈0．05）。NIV治疗后血浆BNP、ET-1和AngII水平随心衰的纠正而显著降低（P〈0．01），与LVEF呈显著负相关（P〈0．01）。结论：NIV在改善老年重度心力衰竭患者心功能同时，也降低患者血浆BNP、ET-1和AngII水平，NIV对老年重度心力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 Non-invasive Ventilation on Plasma Concentration of Brain Natriuretic Peptide, Endothelin-1 and Angiotensin II in Senior Patients with Severe Heart Failure

To investigate the curative effects of non-invasive ventilation(NIV)on senior patients with severe heart failure and the influence on plasma brain natriuretic peptide(BNP),endothelin-1(ET-1) and angiotensin II(Ang Ⅱ),forty two senior patients with severe heart failure were randomly divided into treatment group and control group.The control group(21 cases) was treated by routine therapy include cardiotonic,diuretics,vasodilatation drugs and supplying oxygen via nasal catheter.The treatment group(21 cases) was treated by NIV combined with routine therapy 3-5 days.The clinical signs,blood pressure,heart rate,respiratory rate,blood-gas analysis(PaO2,SaO2) and left ventricular ejection fraction(LVEF) were observed before and after treatment for 3-5 days.The concentrations of plasma BNP,ET-1 and Ang Ⅱ were also measured at the beginning and 3-5 days later.The results showed that the clinical symptoms and signs significantly improved;the SaO2,PaO2 and LVEF significantly elevated(P<0.05);RR significantly reduced(P<0.05) in NIV group compared with those in routine therapy group.The plasma levels of BNP,ET-1 and Ang Ⅱ were significantly decreased after treatment in both groups,especially in the treatment group(P<0.01).The plasma levels of BNP,ET-1 and Ang Ⅱ had a significantly negative correlation with LVEF(P<0.01).The non-invasive ventilation could significantly improve heart function on senior patients with severe heart failure and has an on neuro-endocrine mechanisms.