中华老年医学杂志
中華老年醫學雜誌
중화노년의학잡지
Chinese Journal of Geriatrics
2014年
11期
1157-1160
,共4页
李亚清%严建平%许武林%任卓超
李亞清%嚴建平%許武林%任卓超
리아청%엄건평%허무림%임탁초
肺心病%呼吸功能不全%利钠肽,脑%连续气道正压通气
肺心病%呼吸功能不全%利鈉肽,腦%連續氣道正壓通氣
폐심병%호흡공능불전%리납태,뇌%련속기도정압통기
Pulmonary heart disease%Respiratory insufficiency%Natriuretic peptide,brain%Continuous positive airway pressure
目的 探讨血浆N端脑利钠肽前体(NT proBNP)在慢性肺源性心脏病(CPHD)合并Ⅱ型呼吸衰竭中的作用及双水平气道正压(BiPAP)对其的影响. 方法 将80例CPHD合并Ⅱ型呼吸衰竭患者分为常规治疗组和BiPAP通气组各40例,分别在治疗前及治疗120 h后进行慢性阻塞性肺疾病患者自我评估测试(CAT)、急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和血气分析,以电化学发光法检测血浆NT-proBNP水平. 结果 CPHD合并Ⅱ型呼吸衰竭患者治疗前血浆NT-proBNP与CAT评分(r=0.506,P=0.002)、APACHEⅡ评分(r=0.603,P=0.003)和PaCO2(r=0.539,P＝0.003)均呈正相关,与PaO2均呈负相关(r=-0.465,P=0.014).与治疗前比较,两组患者治疗120 h后CAT评分、APACHEⅡ评分、血氧分压(PaO2)和血二氧化碳分压(PaCO2)均有明显改善;且与常规治疗组比较,BiPAP通气治疗能更明显改善APACHEⅡ评分(t=5.55,p＝0.002)、提高PaO2(t=5.92,P＝0.001)及降低PaCO2(t=4.12,P=0.000).常规治疗组和BiPAP通气组治疗120-h血浆NT-proBNP分别为(341.2±107.6)ng/L和(273.3±82.2) ng/L,均较治疗前(823.8±149.0)ng/L和(832.7±163.0)ng/L显著下降(t＝21.72、28.19,均P=0.000);且与常规治疗组比较,BiPAP通气组治疗120 h后血浆NT-proBNP下降更为显著(t=4.17,P＝0.002).结论 血浆NT-proBNP水平能反映CPHD合并Ⅱ型呼吸衰竭患者病情的严重程度;BiPAP通气治疗能降低CPHD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平,是治疗CPHD合并Ⅱ型呼吸衰竭的有效手段.
目的 探討血漿N耑腦利鈉肽前體(NT proBNP)在慢性肺源性心髒病(CPHD)閤併Ⅱ型呼吸衰竭中的作用及雙水平氣道正壓(BiPAP)對其的影響. 方法 將80例CPHD閤併Ⅱ型呼吸衰竭患者分為常規治療組和BiPAP通氣組各40例,分彆在治療前及治療120 h後進行慢性阻塞性肺疾病患者自我評估測試(CAT)、急性生理與慢性健康狀況評分Ⅱ(APACHEⅡ)和血氣分析,以電化學髮光法檢測血漿NT-proBNP水平. 結果 CPHD閤併Ⅱ型呼吸衰竭患者治療前血漿NT-proBNP與CAT評分(r=0.506,P=0.002)、APACHEⅡ評分(r=0.603,P=0.003)和PaCO2(r=0.539,P＝0.003)均呈正相關,與PaO2均呈負相關(r=-0.465,P=0.014).與治療前比較,兩組患者治療120 h後CAT評分、APACHEⅡ評分、血氧分壓(PaO2)和血二氧化碳分壓(PaCO2)均有明顯改善;且與常規治療組比較,BiPAP通氣治療能更明顯改善APACHEⅡ評分(t=5.55,p＝0.002)、提高PaO2(t=5.92,P＝0.001)及降低PaCO2(t=4.12,P=0.000).常規治療組和BiPAP通氣組治療120-h血漿NT-proBNP分彆為(341.2±107.6)ng/L和(273.3±82.2) ng/L,均較治療前(823.8±149.0)ng/L和(832.7±163.0)ng/L顯著下降(t＝21.72、28.19,均P=0.000);且與常規治療組比較,BiPAP通氣組治療120 h後血漿NT-proBNP下降更為顯著(t=4.17,P＝0.002).結論 血漿NT-proBNP水平能反映CPHD閤併Ⅱ型呼吸衰竭患者病情的嚴重程度;BiPAP通氣治療能降低CPHD閤併Ⅱ型呼吸衰竭患者血漿NT-proBNP水平,是治療CPHD閤併Ⅱ型呼吸衰竭的有效手段.
목적 탐토혈장N단뇌리납태전체(NT proBNP)재만성폐원성심장병(CPHD)합병Ⅱ형호흡쇠갈중적작용급쌍수평기도정압(BiPAP)대기적영향. 방법 장80례CPHD합병Ⅱ형호흡쇠갈환자분위상규치료조화BiPAP통기조각40례,분별재치료전급치료120 h후진행만성조새성폐질병환자자아평고측시(CAT)、급성생리여만성건강상황평분Ⅱ(APACHEⅡ)화혈기분석,이전화학발광법검측혈장NT-proBNP수평. 결과 CPHD합병Ⅱ형호흡쇠갈환자치료전혈장NT-proBNP여CAT평분(r=0.506,P=0.002)、APACHEⅡ평분(r=0.603,P=0.003)화PaCO2(r=0.539,P＝0.003)균정정상관,여PaO2균정부상관(r=-0.465,P=0.014).여치료전비교,량조환자치료120 h후CAT평분、APACHEⅡ평분、혈양분압(PaO2)화혈이양화탄분압(PaCO2)균유명현개선;차여상규치료조비교,BiPAP통기치료능경명현개선APACHEⅡ평분(t=5.55,p＝0.002)、제고PaO2(t=5.92,P＝0.001)급강저PaCO2(t=4.12,P=0.000).상규치료조화BiPAP통기조치료120-h혈장NT-proBNP분별위(341.2±107.6)ng/L화(273.3±82.2) ng/L,균교치료전(823.8±149.0)ng/L화(832.7±163.0)ng/L현저하강(t＝21.72、28.19,균P=0.000);차여상규치료조비교,BiPAP통기조치료120 h후혈장NT-proBNP하강경위현저(t=4.17,P＝0.002).결론 혈장NT-proBNP수평능반영CPHD합병Ⅱ형호흡쇠갈환자병정적엄중정도;BiPAP통기치료능강저CPHD합병Ⅱ형호흡쇠갈환자혈장NT-proBNP수평,시치료CPHD합병Ⅱ형호흡쇠갈적유효수단.
Objective To investigate the effect of bilevel positive airway pressure (BiPAP) ventilation on N terminal pro-brain natriuretic peptide (N proBNP) in patients with chronic pulmonary heart disease (CPHD) and hypercapnic respiratory failure.Methods Eighty patients with CPHD and hypercapnic respiratory failure were randomized into the conventional group (n=40) and BiPAP ventilation group (n=40).The COPD assessment test (CAT) score,APACHE Ⅱ score,arterial blood gas were measured and plasma level of N proBNP was detected by electrochemiluminescence immunoassay before and 120 h after treatment.The correlations of plasma N-proBNP levels with CAT scores,APACHE Ⅱ scores,levels of PaO2 and PaCO2 were analyzed.Results The plasma NT-proBNP level had positive correlations with PaCO2 level (r=0.539,P =0.003),CAT score (r＝0.506,P＝0.002,APACHEⅡ score (r=0.603,P=0.003),and had negative correlation with PaO2 level (r=-0.465,P=0.014) in the patients with CPHD and hypercapnic respiratory failure before treatment.Compared with pre-treatment,the scores of CAT and APACHE Ⅱ,the levels of PaO2 and PaCO2 were significantly improved 120 h after treatment.The improvements in APACHE Ⅱ,PaO2 and PaCO2 were more obviously significant in BiPAP ventilation group than in conventional group (t=5.55,5.92,4.12,respectively,P=0.002,0.001 and 0.000).The plasma levels of NT proBNP in both conventional and BiPAP ventilation groups were significantly descended 120 h after treatment than pre-treatment [(341.2±107.6) ng/L vs.(823.8±149.0) ng/L,(273.3±82.2) ng/L vs.(832.7± 163.0) ng/L,t=21.72,28.19,both P＜0.001],and the decrease of NT-proBNP level was more significantly in BiPAP ventilation group than in conventional group (t=4.17,P=0.002).Conclusions Plasma NT-proBNP level can reflect the severity of chronic pulmonary heart disease combined with hypercapnic respiratory failure.BiPAP ventilation can decrease the plasma level of NT proBNP in patients with CPHD and hypercapnic respiratory failure,which is an effective treatment for chronic pulmonary heart disease combined with hypercapnic respiratory failure.
