BiPAP无创通气治疗急性左心功能衰竭对心功能和血浆内皮素、一氧化氮和脑钠肽浓度的影响

Effects of BiPAP non-invasive ventilation on plasma ET-1,NO and BNP concentrations and cardiac function in patients with left heart failure

目的观察双水平气道正压通气(B iPAP)无创正压机械通气在治疗急性左心功能衰竭过程中对患者血浆内皮素(ET-1)、一氧化氮(NO)和脑钠肽(BNP)的影响。探讨B iPAP治疗急性心肌梗死伴急性左心功能衰竭的作用机制。方法急性心肌梗死伴急性左心功能衰竭患者33例,K illip心功能分级Ⅲ级或Ⅳ级,随机分为两组,常规治疗组(15例)给予常规治疗;无创通气组(18例)在常规治疗的基础上使用B iPAP-V ision呼吸机进行无创正压机械通气。持续治疗2周。分别于治疗前和治疗后测定血浆ET-1、NO和BNP的浓度。结果与常规治疗组比较,无创通气组患者血浆者ET-和lBNP均较治疗前有明显下降,NO水平则显著增高(P<0.01)。结论急性心肌梗死伴急性左心功能衰竭患者早期使用B iPAP呼吸机进行无创正压机械通气治疗可显著降低患者体内的ET-、lBNP水平;升高NO水平,并且能够改善心功能。

Objective To investigate the effects of BiPAP non-invasive positive pressure ventilation on plasma endothelin（ET-1）,NO and B-type natriuretic peptide（BNP） expression in patients with acute left heart failure.Methods Thirty-three patients suffered from AMI with Killip cardiac function of grade Ⅲ or Ⅳ complicated with acute left heart failure were enrolled in this study.The patients were randomly divided into two groups： traditional therapy group which received only routine treatment（n=23） and non-invasive ventilation group using BiPAP-Vision ventilator（n=37）.Blood samples were taken immediately before and two weeks after treatment for determination of plasma concentrations of ET-1,NO and BNP.Results Plasma ET-1 and BNP concentration were significantly lower and plasma NO concentrations were significantly higher after non-invasive positive pressure ventilation treatment in non-invasive ventilation group than in traditonal therapy group.Conclusion Non-invasive positive pressure ventilation can decrease plasma ET-1 and BNP level and increase NO level,and improve cardiac function in patients with AMI complicated with acute left heart failure.