BiPAP无创通气在老年重症肺炎并发心力衰竭治疗中的作用  

Effects of bi-positive airway pressure noninvasive ventilation treatment on plasma concentration of brain natriure-tic peptide for severe pneumonia in elderly patients with heart failure

作　　者：李微[1] 殷少军[1] 李瑾[1] 祝炜[1] 陆卫东[1] 樊美红[1] 张毅琴[1] 林桦[1] 

机构地区：[1]同济大学附属第十人民医院老年科,上海市200072

出　　处：《实用老年医学》2013年第7期551-553,共3页Practical Geriatrics

基　　金：上海市干部保健局科研基金资助项目(2011GB24);上海市卫生局科研基金项目(2010082)

摘　　要：目的评价双水平气道正压(bi-positive airway pressure,BiPAP)无创通气在老年重症肺炎并发左心衰竭抢救中的临床价值,并观察BiPAP无创通气治疗前后血浆脑钠肽(brain natriureticpeptide,BNP)水平的变化。方法老年重症肺炎并发左心衰竭患者36例,随机分为BiPAP治疗组(18例)和内科常规治疗组(18例)。内科常规治疗组为抗感染、止咳化痰、平喘、扩血管、强心、利尿以及鼻导管给氧治疗。BiPAP治疗组在内科常规治疗同时加用BiPAP无创通气治疗72h,分别观察治疗72h后2组患者心率(HR)、呼吸频率(RR)、血压、血氧饱和度、血气分析和临床症状体征以及血浆BNP水平的变化。结果与内科常规治疗组比较,BiPAP治疗组治疗72h后,患者临床症状与体征改善明显,其血氧饱和度(SaO2)、动脉氧分压(PaO2)显著升高,HR、RR显著下降(P<0.05),血浆BNP水平显著降低(P<0.01)。结论 BiPAP无创通气治疗老年重症肺炎并发左心衰竭能迅速纠正缺氧、改善临床症状,降低血浆BNP浓度,是抢救老年重症肺炎并发左心衰竭的一种安全、有效措施。Objective To evaluate the clinical value of bi-positive airway pressure (BiPAP)noninvasive ventilation in treating severe pneumonia complicated with left heart failure in elderly patients and the influence on plasma brain na-triuretic peptide(BNP). Methods Thirty-six elderly patients with severe pneumonia complicated with left heart failure were randomly divided into treatment group and control group.The treatment group (18 cases) was treated by BiPAP combined with routine therapy,and the control group (18 cases) treated by routine therapy including anti-infection,antitussive and expectorant, anti-asthma,vasodilator,nitrates,cedilanid,diuretics combined with oxygen before and 72 hours after treatment. Systolic blood pressure,heart rate,respiratory rate,blood-gas analysis(pH,PaO2,PaCO2,SaO2) and the clinical signs were observed 72 hours after treatment.The concentrations of plasma BNP was also measured before and 72 hours after treatment. Results The clinical symptoms and signs were significantly improved,SaO2 and PaO2 significantly elevated,RR,HR significantly reduced(P<0.05) in treatment group than those in control group.The plasma level of BNP were significantly decreased after treatment in both groups,especially in the treatment group(P<0.01). Conclusions BiPAP could improve hypoxemia and cardiac function and reduce the plasma BNP concentration in elderly patients with severe pneumonia complicated with heart failure.

关 键 词：双水平气道正压 无创通气 老年人 重症肺炎 心力衰竭 脑钠素 

分 类 号：R563.1[医药卫生—呼吸系统] R541.6[医药卫生—内科学]