长期无创机械通气对终末期肺心病患者右心室结构和功能变化的临床观察  

The Clinical Effects of Long-term Noninvasive Mechanical Ventilation on Improvement of Right Ventricular Structure and Function Disorder among End-stage Cor Pulmonale Patients

作　　者：李志军[1] 顾亮[1] 吴金彦[1] 杜坚宗[1] 吴文娟[1] 钦光跃[1] 

机构地区：[1]浙江医院呼吸内科,310013

出　　处：《心脑血管病防治》2014年第6期461-463,共3页CARDIO-CEREBROVASCULAR DISEASE PREVENTION AND TREATMENT

摘　　要：目的观察长期无创机械通气对肺心病右心室结构及功能的改善作用。方法采用病例-对照研究,对纳入本研究患者随机分为观察组（27例）与对照组（25例）,观察组在常规治疗基础上,采用长期无创机械通气治疗1年,观察治疗前后肺动脉收缩压、右心室结构参数如右心室流出道内径（RVOT）、右心室舒服张末期内径（RVD）、右心室壁厚度（RVWT）、右肺动脉内径（RPA）、左、右心室内径的比值（LV/RV）和脑钠肽前体（pro-BNP）等指标。结果两组患者治疗后pro-BNP明显降低,与治疗前比较差异有统计学意义（P〈0.01）,且观察组治疗后较对照组下降更明显,差异有统计学意义（P〈0.05）;两组患者治疗后肺动脉收缩压显著降低,同治疗前比较差异有统计学意义（P〈0.05）,但治疗后两组差异无统计学意义（P〉0.05）。两组患者治疗后右心室各结构参数显著改善,同治疗前比较差异具有统计学意义（P〈0.05,〈0.01）,但治疗后两组组间比较差异无统计学意义（P〉0.05）。pearson相关分析显示肺动脉收缩压同右心室各结构参数呈显著正相关（r=0.47-0.65）,P〈0.01）。结论长期无创机械通气可以明显降低肺心病患者肺动脉高压,改善右心室结构和功能。Objective To observe the clinical effects of long-term noninvasive mechanical ventilation on right ventricular structure and function disorder in end-stage cor pulmonale patients.Methods By case-control study ,all patients were randomly divided into observation group and control group.Based on regular treatment ,pulmonary arterial systolic pressure ,structural parameters of right ventricle （RVOT ,RVD ,RVWT ,RPA and LV/RV） and pro-BNP were evaluated in the observation group before and after one year of using long-term noninvasive mechanical ventilation.Results Pro-BNP reduced after treatment ,and there was a significant difference （ P〈0.01 ） ,compared with that before treatment ;the index in the observation group had a great decrease compared with control group , there was a significant difference（P〈0.05）.There was a significant reduction of pulmonary arterial systolic pressure of all patients after the treatment ,compared with that before treatment（P〈0.05）.However ,there were no significant differences between the two groups after treatment （ P〉0.05 ）.The structural parameters of right ventricle of all patients after treatment had a great improvement , and there was a significant difference compared with that before treatment （ P〈0.05;〈0.01）. However ,there were no significant differences between two groups after treatment （ P〉0.05）.Pearson correlation analysis showed the pulmonary arterial systolic pressure and structural parameters of right ventricle had significant positive correlation （r=0.47~0.65 ,P〈0.01 ）.Conclusions Long-term noninvasive mechanical ventilation can reduce pulmonary arterial hypertension and improve right ventricular structure and function.

关 键 词：肺心病 无创机械通气 肺动脉收缩压 右室结构 

分 类 号：R541.5[医药卫生—心血管疾病]