双水平正压通气对老年肺心病失代偿期患者血浆脑钠素、内皮素-1和血管紧张素Ⅱ水平的影响  

Study of bi-level positive airway pressure ventilation therapy on plasma concentration of brain natriuretic peptide,endothelin-1 and angiotensin Ⅱ in senior patients with cor pulmonale(instable stage)

作　　者：殷少军[1] 吕中伟[2] 董福轮[1] 傅佩芳[3] 颜正茂[3] 张国良[3] 

机构地区：[1]同济大学附属第十人民医院老年科,上海200072 [2]同济大学附属第十人民医院核医学科,上海200072 [3]同济大学附属第十人民医院呼吸内科,上海200072

出　　处：《中国临床保健杂志》2010年第2期127-130,共4页Chinese Journal of Clinical Healthcare

摘　　要：目的探讨老年慢性肺心病失代偿期时血浆脑钠素(BNP)、内皮素-1(ET-1)和血管紧张素II(AngⅡ)水平的变化及双水平正压通气(BiPAP)治疗对其影响。方法老年慢性肺心病失代偿期患者60例,随机分为BiPAP治疗组(30例)和常规治疗组(30例)。常规治疗组为降肺动脉压、强心、利尿剂、血管扩张剂等药物并加用鼻导管给氧治疗。BiPAP治疗组,在常规内科治疗同时加用BiPAP治疗,分别观察治疗72h后两组患者临床症状、体征、心率(HR)、呼吸频率(RR)、血压、血气分析、一秒钟用力呼气容积(FEV1)、肺动脉压(PAP)以及血浆BNP、ET-1和AngⅡ的变化。结果与常规治疗组比较,BiPAP组治疗72h后,患者临床症状与体征改善明显,其SaO2、PaO2和FEV1显著升高(P<0.05),PAP、HR、RR显著下降(P<0.05)。BiPAP治疗后血浆BNP、ET-1和AngⅡ水平随缺氧的纠正而显著降低(P<0.01),与PaO2呈显著负相关(P<0.01),与PAP呈显著正相关(P<0.01)。结论BiPAP在改善老年慢性肺心病失代偿期患者氧和功能和降低PAP的同时,也降低患者血浆BNP、ET-1和AngⅡ水平。Objective To investigate the curative effects of bi-level positive airway pressure（BiPAP）therapy on senior patients with cor pulmonale（instable stage）and the influence on plasma brain natriuretic peptide（BNP）,endothelin-1（ET-1）and angiotensin II（AngⅡ）.Methods 60 senior patients with cor pulmonale（instable stage）were randomly divided into treatment group and control group.The control group（30 cases）by routine therapy include reduced pulmonary artery pressure,cediland,diuretics,vasodilation drugs and supplying oxygen via nasal catheter.The treatment group（30 cases）was treated by bi-level positive airway pressure（BiPAP）combined with routine therapy 72 h.The clinical signs,blood pressure,heart rate,respiratory rate,blood-gas analysis（PaO 2,SaO 2）,forced expiratory volume in one second（FEV 1）,pulmonary artery pressure（PAP）were observed before and after treatment for 72 h.The concentrations of plasma BNP,ET-1 and Ang Ⅱ were also measured at the beginning and 72h after treatment.Results The clinical symptoms and signs significantly improved,SaO 2,PaO 2 and FEV 1 significantly elevated（P0.05）,PAP,RR significantly reduced（P0.05）in BiPAP therapy group than those in routine therapy group.The plasma levels of BNP,ET-1 and AngⅡ were significantly decreased after treatment in both groups,especially in BiPAP therapy group（P0.01）.The plasma levels of BNP,ET-1 and AngⅡ had a significantly negative correlation with PaO 2 （P0.01）,and positive correlation with PAP（P0.01）.Conclusion BiPAP therapy could significantly improve oxygenation function and decrease the levels of plasma BNP、ET-1 and AngⅡ in senior patients with cor pulmonale（instable stage）.

关 键 词：肺心病 连续气道正压通气 心力衰竭 利钠肽 脑 内皮素-1 血管紧张素Ⅱ 老年人 

分 类 号：R541.5[医药卫生—心血管疾病]