双水平气道内正压通气对老年心功能Ⅳ级患者氨基端脑钠肽原的影响

Effect of bi-level positive airway pressure ventilation to N-terminal pro-brain natriuretic peptide in grade Ⅳ elderly heart failure patients

目的探讨双水平气道内正压通气(BiPAP)对老年心功能Ⅳ级患者氨基端脑钠肽原(NT-proBNP)的影响。方法将84例老年心功能Ⅳ级患者随机分为2组:对照组用常规抗心衰治疗;BiPAP组在给予常规抗心衰治疗同时加用BiPAP呼吸机,治疗前及治疗后24h、14d进行NT-proBNP分析,并监测心衰的症状与体征。结果BiPAP组患者呼吸频率减慢,心率下降,心衰症状缓解,总有效率为90.5%;对照组总有效率仅为42.9%,两组比较差异有统计学意义(P<0.01)。BiPAP组患者NT-proBNP在治疗后24h、14d由治疗前的(2434.2±298.4)ng/L下降至(2011.7±302.5)ng/L、(486.3±85.7)ng/L;对照组患者NT-proBNP在治疗后24h、14d由治疗前的(2393.8±193.5)ng/L下降至(2185.4±494.6)ng/L、(1878.4±421.6)ng/L,两组比较差异有统计学意义(P<0.01)。血浆NT-proBNP水平与心功能的级别呈密切正相关(r2=0.979,P<0.01)。结论使用BiPAP呼吸机治疗老年心功能Ⅳ级患者可以减少NT-proBNP释放,发挥其改善心脏功能的作用,提高抢救成功率,是一种有效安全的方法。

Objective To investigate the effect of bi-level positive airway pressure ventilation （PiPAP） to N- terminal pro-brain natriuretic peptide （NT proBNP） in grade Ⅳ elderly heart failure patients. Methods Grouping randomly 84 elderly cases with grade Ⅳ heart failure into two groups： the control group was treated with conventional therapy ; the BiPAP group was treated with BiPAP ventilator besides conventional therapy. The NT-proBNP before treatment and 24 h, 14 d after treatment was analyzed, and the symptom and physical sign of heart failure were monitored. Results The BiPAP group appeared step down of their breathing frequency, the descend of their heart rate, and the symptomatic relief of heart failure. The total effective rate of BiPAP group was 90.5 % ; and that of the control group was 42.9 %. The difference between two groups had statistical significance（P〈 0.01）. The NT proBNP of BiPAP group before treatment was （2434. 2 ± 298. 4）ng/L, but 24h and 14d after treatment descended to （2011.7±302. 5）ng/L and （486. 3±85. 7）ng/L, The NTpro BNP of the control group before treatment was （2393.8±193. 5） ng/L, but 24 h and 14 d after treatment descend to （2185. 4±494. 6）ng/L and （1878. 4± 421.6）ng/L. The difference between two groups had statistical significance（P〈 0.01）. The plasma NT-proBNP was positively correlated with heart function intimately（rz =0. 979,P〈0. 01）. Conclusion To use BiPAP ventilator in geriatric heart failure of grade IV will reduce the liberation of NT-proBNP, thereby improve the cardiac function and elevate the achievement ratio of rescue. It is an effective and safe method.