血浆BNP水平在老年COPD患者呼吸机脱机中的评估  

The Evaluation of Brain Natriuretic peptide during Weaning in Elderly Patients with Chronic Obstructive Pulmonary Disease

作　　者：许强宏[1] 严静[1] 龚仕金[1] 蔡国龙[1] 吴亮[1] 戴海文[1] 陈进[1] 

机构地区：[1]浙江医院,浙江杭州310013

出　　处：《心脑血管病防治》2011年第4期267-269,I0001,I0002,共5页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

基　　金：浙江省医药卫生科学研究基金(2007A016)

摘　　要：接受机械通气的慢性阻塞性肺病（COPD）急性加重患者常常存在脱机困难[1]。呼吸力学加重和所产生的呼吸肌疲劳、肺动脉嵌压升高、急性左心室缺血、左心室射血分数下降和右心室扩大伴随室间隔左移位[2]是脱机失败的主要原因。COPD患者常出现呼气流速受限导致的肺动态充气过度,Objective To evaluate the utility of serial measurements of plasma brain natriuretic peptide（BNP） by detecting acute cardiac dysfunction during weaning failure for elderly patients with chronic obstructive pulmonary disease in difficult to wean.Methods 60 elderly patients with chronic obstructive pulmonary disease were divided into two groups： BNP application group（30 cases）and standard therapy group（30 cases）.Cardiac and hemodynamic variables,arterial blood gas,respiratory mechanics and indexes of oxygen cost of breathing,were measured and analyzed immediately before（baseline） and at the end of a spontaneous breathing trial.Plasma levels of BNP and each measurement of BNP after every hour was measured in application BNP group.BNP was measured in Application BNP group and according to BNP value,patients were divided into two groups： normal group and increased group;Before and after weaning,LVEF was measured by echocardiographys.Results Compared with standard therapy group,HR SBP DBP SaO2 RR PaO2/FiO2 PH,PaCO2,PaO2 of the patients with increased BNP value in BNP application group,increased significantly after SBT（P0.05）;Compared with normal group,HR SBP DBP SaO2 RR PaO2/FiO2 PH,PaCO2,PaO2 of the patients with increased BNP value in BNP application group increased significantly（P0.05）.In BNP application group,patients who weaned successfully were more than the standard therapy group.Conclusions Serial measurements of BNP plasma levels provide a noninvasive manner to detect acute cardiac dysfunction during an unsuccessful weaning trial for the elderly patients in difficult to wean with chronic obstructive pulmonary disease in difficult to wean.The use of BNP can improve the success rate of weaning outcome.

关 键 词：COPD患者 呼吸机脱机 P水平 慢性阻塞性肺病 左心室射血分数 评估 老年 BN 

分 类 号：R563.9[医药卫生—呼吸系统]