有创和无创正压通气对COPD急性加重并严重呼吸衰竭患者血浆脑钠肽含量的影响  

Effect of invasive and non-invasive positive pressure ventilation on plasma brain natriuretic peptide in patients with chronic obstructive pulmonary disease and severe respiratory failure

作　　者：杨红辉[1] 周妍[1] 

机构地区：[1]中南大学湘雅三医院呼吸内科,湖南长沙410013

出　　处：《南方医科大学学报》2010年第10期2377-2379,共3页Journal of Southern Medical University

摘　　要：目的探讨无创正压通气和有创正压通气对慢性阻塞性肺病(COPD)急性加重并严重呼吸衰竭患者血浆脑钠肽(BNP)含量的影响。方法选择56例COPD急性加重并严重呼吸衰竭患者,随机分成两组,每组28例。无创通气组在常规治疗的基础上加用面罩呼吸机辅助呼吸,有创通气组在常规治疗的基础上给予气管插管或气管切开呼吸机辅助呼吸。分别观察治疗前、治疗后24h两组患者血气分析及血浆BNP含量的变化。结果机械通气后24h两组的动脉血气指标PH、PO2及PaCO2与入院时比较均明显改善(与治疗前比较,a1=-8.68a2=-9.25a3=11.55b1=-9.48b2=-28.92b3=22.78aP<0.05,与无创通气组比较,ab1=-3.49ab2=-2.80ab3=8.39abP<0.05),有创通气组比无创通气组改善显著,差异有统计学意义(P<0.05)。治疗后24h两组患者血浆BNP均较治疗前下降,治疗后有创通气组较无创通气组血浆BNP下降显著,差异有统计学意义(P<0.05)。结论有创正压通气治疗COPD急性加重并严重呼吸衰竭较无创正压通气治疗效果显著。机械通气可降低BNP浓度,其浓度变化可用于疗效评价。Objective To investigate the change in plasma brain natriuretic peptide（BNP） in patients with chronic obstructive pulmonary disease（COPD） and severe respiratory failure receiving invasive or non-invasive positive pressure ventilation.Methods Fifty-six patients with COPD and severe respiratory failure were randomized into non-invasive ventilation group（n=28） to receive facial mask ventilation and invasive ventilation group（n=28） to have mechanical ventilation by tracheal intubation or tracheal incision.The changes of blood gasses and BNP before and 24 h after the ventilation were observed.Results The indexes of blood gas analysis such as pH,PO2 and PaCO2 in the invasive ventilation group were betterthan those in the non-invasive ventilation group（P0.05）.The plasma levels of BNP of the invasive ventilation group were much lower 24 h afterthe treatment than that of the non-invasive ventilation group（P0.05）.Conclusions Invasive ventilation produces bettereffect than non-invasive ventilation in the treatment of COPD with severe respiratory failure.Plasma concentrations of BNP has significant clinical value to evaluate the effect of mechanical ventilation.

关 键 词：有创正压通气 无创正压通气 慢性阻塞性肺疾病 呼吸衰竭 脑钠肽 

分 类 号：R563.8[医药卫生—呼吸系统]