有创-无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆 ANP与NT-proBNP的影响分析  

Effect of Invasive and Noninvasive Sequential Mechanical Ventilation on Plasma ANP and NT-proBNP in Patients with Severe Pneumonia Complicated with Respiratory Failure

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作  者:李世泽 陆红红 Li Shize(Department of Respiratory and Critical Care Medicine,Jiangmen People’s Hospital,Jiangmen Guangdong 529000)

机构地区:[1]广东省江门市人民医院呼吸与危重症医学科,广东江门529000

出  处:《黑龙江医药》2025年第2期256-260,共5页Heilongjiang Medicine journal

基  金:江门市科技计划项目(编号:2024YL03002)。

摘  要:目的:探讨有创-无创(IMV-NIV)序贯机械通气治疗重症肺炎(SP)合并呼吸衰竭(RF)患者对血浆心房钠尿肽(ANP)与N末端B型钠尿肽前体(NT-proBNP)水平的影响。方法:选取2024年4月—2024年10月收治的70例行机械通气治疗的SP并RF患者,采取摸球法随机分为观察组和对照组各35例,对照组行有创机械通气治疗,观察组行IMV-NIV序贯治疗,比较治疗前及治疗24h后两组患者心率(HR)、呼吸频率(RR)水平、动脉血气分析指标水平[氧分压(PaO 2)、二氧化碳分压(PaCO 2)、氧合指数(PaO 2/FiO 2)]、治疗前及治疗3天后血清炎性指标水平[白介素-4(IL-4)、白介素-6(IL-6)、白介素-10(IL-10)、超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)]、心损伤标志物指标水平[ANP、肌钙蛋白I(cTnI)、NT-proBNP]、总住院时间、ICU住院时间、有创通气时间、机械通气时间、呼吸机相关性肺炎(VAP)发生率及撤机成功率。结果:治疗24h后两组患者HR、RR、PaCO 2水平相较于治疗前均显著降低,PaO 2、PaO 2/FiO 2水平相较于治疗前均显著升高,但两组间对比差异无统计学意义(P>0.05)。治疗前两组IL-4、IL-6、IL-10、hs-CRP、TNF-α、ANP、cTnI、NT-proBNP水平无差异(P>0.05),治疗3天后观察组IL-4、IL-6、hs-CRP、TNF-α、ANP、cTnI、NT-proBNP水平均低于对照组,IL-10水平高于对照组,差异具有统计学意义(P<0.05)。观察组总住院时间、ICU住院时间、有创通气时间、机械通气时间均短于对照组(P<0.05)。观察组VAP发生率低于对照组,撤机成功率高于对照组,差异均具有统计学意义(P<0.05)。结论:IMV-NIV序贯治疗SP并RF患者在纠正缺氧状态、减少二氧化碳潴留、恢复通气功能方面与传统有创机械通气治疗效果相当,但IMV-NIV序贯治疗可缩短患者通气治疗时间,减轻炎症反应和心损伤水平,同时提高撤机成功率,降低并发症发生率。Objective:To investigate the effects of sequential mechanical ventilation(IMV-NIV)on atrial natriuretic peptide(ANP)and N-terminal B-type natriuretic peptide(NT-proBNP)levels in patients with severe pneumonia(SP)complicated with respiratory failure(RF).Methods:Seventy SP and RF patients receiving mechanical ventilation treatment from April 2024 to October 2024 were selected and randomly divided into observation group and control group with 35 cases in each group by touch ball method.The control group received invasive mechanical ventilation treatment,and the observation group received IMV-NIV sequential treatment.The levels of heart rate(HR),respiratory rate(RR)and arterial blood gas analysis indexes[partial pressure of oxygen(PaO 2),partial pressure of carbon dioxide(PaCO 2)and oxygenation index(PaO 2/FiO 2)]were compared before treatment and 24h after treatment.Serum levels of inflammatory markers[interleukin-4(IL-4),interleukin-6(IL-6),interleukin-10(IL-10),hypersensitive C-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α)],markers of heart injury[ANP,troponin I(cTnI),NT-before treatment and 3 days after treatment proBNP],total hospital stay,ICU stay,invasive ventilation time,mechanical ventilation time,incidence of ventilators associated pneumonia(VAP)and success rate of withdrawal.Results:After 24h of treatment,the levels of HR,RR and PaCO 2 in both groups were significantly decreased compared with before treatment,while the levels of PaO 2 and PaO 2/FiO 2 were significantly increased compared with before treatment,but there was no statistical significance between the two groups(P>0.05).There were no differences in the levels of IL-4,IL-6,IL-10,hs-CRP,TNF-α,ANP,cTnI and NT-proBNP between the two groups before treatment(P>0.05).After 3 days of treatment,the levels of IL-4,IL-6,hs-CRP,TNF-α,ANP,cTnI and NT-proBNP in the observation group were lower than those in the control group,and the levels of IL-10 were higher than those in the control group,with statistical significance(P<0.05).The total hospita

关 键 词:重症肺炎 呼吸衰竭 有创-无创序贯机械通气 心损伤 

分 类 号:R563.1[医药卫生—呼吸系统]

 

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