静脉利尿扩血管联合治疗对慢性阻塞性肺疾病急性加重期患者血浆BNP水平的影响  

The effect of intravenous diuretic and vasodilator therapy on plasma brain natriuretic peptide levels in patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：李琳[1] 吴友茹[1] 徐维国[1] 文富强[2] 

机构地区：[1]绵阳市中心医院呼吸内科,四川绵阳621000 [2]四川大学华西医院呼吸内科,四川成都610041

出　　处：《西部医学》2017年第1期42-44,52,共4页Medical Journal of West China

基　　金：国家科技支撑计划项目(2014BAI08B04)

摘　　要：目的观察静脉利尿扩血管联合治疗对慢性阻塞性肺疾病急性加重期(AECOPD)患者血浆脑钠肽(BNP)水平和健康状况的影响。方法选取2013年10月~2014年5月无肺心病证据的AECOPD患者108例,随机分为两个研究组,在给予抗感染、化痰、平喘等相同治疗的基础上,A组62例使用小剂量利尿剂治疗和B组46例采用利尿剂加血管扩张剂治疗。另选择50例COPD稳定期患者作为对照(C组)。AECOPD患者(A、B组)分别于治疗前、治疗后第3天和第6天检测血浆BNP浓度,给药前后测定圣·乔治呼吸问卷(SGRQ)评分,并与COPD稳定期(C组)患者血浆BNP浓度、圣·乔治呼吸问卷(SGRQ)评分进行比较。结果治疗前A、B组AECOPD患者血浆BNP水平无明显差异(P>0.05),但均高于对照C组(P<0.05)。治疗后AECOPD患者血浆BNP水平均有降低,但B组下降更显著,B组血浆BNP水平明显低于同期A组(P<0.05)。治疗前A、B组患者SGRQ评分无明显差异(P>0.05),但均高于对照C组(P<0.05)。治疗后,AECOPD患者SGRQ评分均有下降,且B组评分明显低于A组(P<0.05)。结论 AECOPD患者血浆BNP水平明显升高,采用静脉利尿血管扩张联合治疗可同时降低血浆BNP水平和SGRQ评分,有利于患者健康状况的改善,可在临床推广应用。Objective To evaluate the effect of intravenous diuretic and vasodilator therapy on plasma brain natriuretic peptide （BNP） levels and health status in patients with acute exacerbations of COPD （AECOPD）. Methods A total of 108 AECOPD patients without corpulmonale were classified based on the treatment received： mild diuretic （Group A）, the diuretic and vasodilator（Group B）. Stable COPD patients were served as controls （Group C）. Plasma BNP concentrations and George＇s Respiratory Questionnaire score were evaluated and compared between the three groups. Results Plasma BNP levels in AECOPD patients were significantly decreased after treatment, and the decrease was more striking in group B than in group A （P^0.05）. Scores of St. George% Respiratory Questionnaire in AECOPD patients were significantly improved after treatment, and the improve was more striking in group B than in group A （P〈0.05）. Conclusion Plasma BNP levels increased during AECOPD. However, the BNP levels and scores of St. George＇s Respiratory Questionnaire decreased after therapy with diuretic and vasodilator.

关 键 词：慢性阻塞性肺疾病 急性加重 B型钠尿肽 利尿 扩血管 

分 类 号：R563[医药卫生—呼吸系统]