老年慢性肺源性心脏病失代偿期患者使用无创呼吸机的疗效观察

目的观察无创呼吸机治疗老年慢性肺源性心脏病（慢性肺心病）失代偿期患者的疗效。方法采用前瞻性研究,选取58例老年慢性肺心病失代偿期患者随机分为无创呼吸机治疗组（观察组）和常规治疗组（对照组）,在给予氧疗、抗感染、平喘祛痰等治疗基础上对照组使用呼吸兴奋剂,而观察组使用双向呼吸道正压通气（BiPAP）呼吸机治疗;比较2组患者治疗1 d、3 d后的血气分析动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）]指标、血清氨基末端脑钠肽前体（NT-ProBNP）、血清肌钙蛋白（TnI）的变化。观察2组急性冠脉综合征的发生率。结果观察组治疗1 d、3 d后血气分析指标明显改善,差异有统计学意义（P〈0.01）;3 d后NTProBNP、TnI明显降低,与对照组比较,差异有统计学意义（P〈0.01）。观察组急性冠脉综合征的发病率明显减低。结论早期应用无创呼吸机治疗老年慢性肺源性心脏病失代偿期患者,可明显改善患者低氧血症及高碳酸血症,降低NT-ProBNP、TnI水平,降低急性冠脉综合征的发生率。

Efficacy of noninvasive ventilator in the treatment of elderly patients with chronic cor pulmonale decompensation stage

Objective To observe the effect of noninvasive ventilation in the treatment of elderly patients with chronic cor pulmonale decompensation stage. Methods A prospective study was conducted,and 58 cases of elderly patients with chronic cor pulmonale decompensation stage were randomly divided into treatment group and control group. Control group received routine therapy,including low concentration of oxygen,anti-infective,anti-asthmatic,expectorant therapy and respiratory stimulants. Treament group received BiPAP therapy additionally. The level of arterial blood gas analysis indexes（ arterial oxygen partial pressure,arterial partial pressure of carbon dioxide）,serum levels of N-terminal pro-brain natriuretic peptide（ NT-ProBNP） and cardiac troponin I（ TnI） before and 1,3 d after treatment were detected and compared. And the incidence rate of acute coronary syndrome was analyzed in the two groups. Results After treatment,the index of blood gas analysis,the levels of NT-ProBNP and TnI were improved significantly in treatment group than those in control group（ P〈0. 01）. The incidence rate of acute coronary syndrome in the treatment group was significantly lower than that in the control group（ P〈 0. 05）. Conclusions The early application of noninvasive ventilation in the treatment of elderly patients with chronic cor pulmonale decompensation,can significantly improve hypoxemia and hypercapnia,and reduce the incidence of acute coronary syndrome rate.