无创正压通气对心力衰竭合并睡眠呼吸暂停患者氨基端-脑钠肽前体水平的影响  

The effects of noninvasive positive pressure ventilation treatment on plasma concentration of amino terminal-pro brain natriuretic peptide in congestive heart failure in patients with sleep apnea

作　　者：赵智慧[1] 柳志红[1] 罗勤[1] 张健[1] 熊长明 倪新海[1] 张澍[1] 杨跃进[1] 马秀平[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院肺血管病诊治中心,北京100037

出　　处：《中华内科杂志》2006年第5期386-388,共3页Chinese Journal of Internal Medicine

基　　金：首都医学发展科研基金资助项目(20032011)

摘　　要：目的观察无创正压通气对心力衰竭合并睡眠呼吸暂停患者血浆氨基端脑钠肽前体(NTproBNP)水平的影响。方法选符合标准的心力衰竭住院患者105例,摄X线胸片,行超声心动图检查及睡眠呼吸监测。凡入选干预治疗者随机分为常规药物治疗组(A组)和常规药物+正压通气治疗组(B组)。所有心衰患者及2组患者治疗前后取静脉血血浆,用竞争性酶联免疫吸附试验测NTproBNP水平。结果(1)105例心力衰竭患者中77例合并睡眠呼吸暂停,随着心功能分级的逐渐递增,NTproBNP水平亦逐渐增高(P<0.05)。(2)B组患者正压通气治疗2～5d后,AHI从(39.34±12.26)次/min降至(7.23±5.23)次/min(P<0.001);最低脉搏血氧饱和度(SpO2)从(73.27±4.75)%升至(83.12±3.86)%(P<0.001);B组患者治疗后NTproBNP水平有所下降(P=0.001);2组间NTproBNP变化比较差异有统计学意义(P=0.03)。结论NTproBNP水平能反映心力衰竭病情的严重程度,短期应用无创通气治疗心力衰竭合并睡眠呼吸暂停,能降低NTproBNP水平。Objective Sleep apnea （SA） exerts adverse effects in patients with congestive heart failure （CHF）. Amino terminal-pro brain natriuretic peptide （NT-proBNP） is a useful target of CHF treatment. The purpose of this study was to assess the short-term effect of positive pressure ventilation （PPV） on the plasma concentration of NT-proBNP in patients with both CHF and SA. Methods One hundred and five patients diagnosed with CHF participated in the study. Medical history was recorded, and Doppler echocardiography and overnight polysomnography were performed. Seventy-seven patients were diagnosed as having SA. Patients with CHF and SA were randomly assigned to receive medical therapy alone （ 12 patients） or with the addition of PPV （ 14 patients） for 2 - 5 days. Results Plasma NT-proBNP concentration was measured in 77 patients with CHF and SA. The plasma level of NT-proBNP was associated with the severity of CHF. Subjects with higher degree of NYHA class showed higher a level of NT-proBNP. After PPV treatment, the apnea-hypopnea index decreased （P 〈 0. 001 ）, the lowest SaO2 increased （P 〈 0. 001 ）, and the plasma concentration of NT-proBNP decreased as compared to the baseline levels （ P 〈 0. 05）. Conclusion The plasma levels of NT-proBNP could reflect the severity of CHF, and PPV treatment could decrease the plasma NT-proBNP level in patients with CHF and SA.

关 键 词：心力衰竭 充血性 睡眠呼吸暂停 无创正压通气 氨基端-脑钠肽前体 

分 类 号：R541.6[医药卫生—心血管疾病] R766.43[医药卫生—内科学]