CAJ | 학술논문

目的：观察长期无创机械通气对肺心病右心室结构及功能的改善作用。方法采用病例－对照研究，对纳入本研究患者随机分为观察组（27例）与对照组（25例），观察组在常规治疗基础上，采用长期无创机械通气治疗1年，观察治疗前后肺动脉收缩压、右心室结构参数如右心室流出道内径（RVOT ）、右心室舒服张末期内径（RVD ）、右心室壁厚度（RVWT）、右肺动脉内径（RPA）、左、右心室内径的比值（LV／RV）和脑钠肽前体（pro_BNP）等指标。结果两组患者治疗后pro_BNP明显降低，与治疗前比较差异有统计学意义（ P＜0.01），且观察组治疗后较对照组下降更明显，差异有统计学意义（ P＜0.05）；两组患者治疗后肺动脉收缩压显著降低，同治疗前比较差异有统计学意义（ P＜0.05），但治疗后两组差异无统计学意义（ P＞0.05）。两组患者治疗后右心室各结构参数显著改善，同治疗前比较差异具有统计学意义（ P＜0.05，＜0.01），但治疗后两组组间比较差异无统计学意义（ P＞0.05）。pearson相关分析显示肺动脉收缩压同右心室各结构参数呈显著正相关（r＝0.47～0.65），P＜0.01）。结论长期无创机械通气可以明显降低肺心病患者肺动脉高压，改善右心室结构和功能。
목적：관찰장기무창궤계통기대폐심병우심실결구급공능적개선작용。방법채용병례－대조연구，대납입본연구환자수궤분위관찰조（27례）여대조조（25례），관찰조재상규치료기출상，채용장기무창궤계통기치료1년，관찰치료전후폐동맥수축압、우심실결구삼수여우심실류출도내경（RVOT ）、우심실서복장말기내경（RVD ）、우심실벽후도（RVWT）、우폐동맥내경（RPA）、좌、우심실내경적비치（LV／RV）화뇌납태전체（pro_BNP）등지표。결과량조환자치료후pro_BNP명현강저，여치료전비교차이유통계학의의（ P＜0.01），차관찰조치료후교대조조하강경명현，차이유통계학의의（ P＜0.05）；량조환자치료후폐동맥수축압현저강저，동치료전비교차이유통계학의의（ P＜0.05），단치료후량조차이무통계학의의（ P＞0.05）。량조환자치료후우심실각결구삼수현저개선，동치료전비교차이구유통계학의의（ P＜0.05，＜0.01），단치료후량조조간비교차이무통계학의의（ P＞0.05）。pearson상관분석현시폐동맥수축압동우심실각결구삼수정현저정상관（r＝0.47～0.65），P＜0.01）。결론장기무창궤계통기가이명현강저폐심병환자폐동맥고압，개선우심실결구화공능。
Objective To observe the clinical effects of long_term noninvasive mechanical ventilation on right ventricular structure and function disorder in end_stage cor pulmonale patients.Methods By case_control study ,all patients were randomly divided into obser-vation group and control group.Based on regular treatment ,pulmonary arterial systolic pressure ,structural parameters of right ventri-cle (RVOT ,RVD ,RVWT ,RPA and LV/RV) and pro_BNP were evaluated in the observation group before and after one year of us-ing long_term noninvasive mechanical ventilation.Results Pro_BNP reduced after treatment ,and there was a significant difference ( P<0.01 ) ,compared with that before treatment ;the index in the observation group had a great decrease compared with control group , there was a significant difference(P<0.05).There was a significant reduction of pulmonary arterial systolic pressure of all patients after the treatment ,compared with that before treatment(P<0.05).However ,there were no significant differences between the two groups after treatment ( P>0.05 ).The structural parameters of right ventricle of all patients after treatment had a great improvement , and there was a significant difference compared with that before treatment ( P<0.05;<0.01). However ,there were no significant differences between two groups after treatment ( P>0.05).Pearson correlation analysis showed the pulmonary arterial systolic pressure and structural parameters of right ventricle had significant positive correlation (r=0.47~0.65 ,P<0.01 ).Conclusions Long_term noninvasive mechanical ventilation can reduce pulmonary arterial hypertension and improve right ventricular structure and function.