无创机械通气治疗AAMI并低氧血症对BNP及预后的影响

Influence of noninvasive mechanical ventilation therapy on BNP and prognosis in patients with AAMI complicated hypoxemia

目的：探讨对急性前壁心肌梗死（AAMI）并低氧血症患者行无创机械通气治疗后患者脑利钠肽（BNP）动态变化，左室射血分数（LVEF）和预后的改善。方法：回顾性分析2011年3月-2013年10月期间收住院的60例 AAMI并低氧血症患者的资料，患者被随机分为无创通气组（28例）与常规治疗组（32例），观察并比较两组患者BNP的动态变化及 LVEF情况。结果：两组治疗后BNP水平及 LVEF均有明显改善（P均＜0.05），与常规治疗组比较，无创通气组治疗后 BNP水平[24h：（263.6±23.3）μmol/L比（126.2±21.9）μmol/L]显著降低、LVEF [（40.6±13.1）％比（47.3±14.7）％]显著上升（P均＜0.01），随访30d后无创通气组较常规治疗组6 min步行距离（426-550m）者比例为75.0％比59.3％、LVEF [（49.4±12.5）％比（41.1±11.7）％]、存活率（96.4％比90.6％）明显增加，再次住院率（7.1％比12.5％）显著降低（P均＜0.01）。结论：急性前壁心肌梗死并低氧血症患者早期行无创机械通气治疗能明显改善患者的心功能，提高患者的运动耐量和存活率。

Objective：To study dynamic change of brain natriuretic peptide （BNP）,left ventricular ejection fraction （LVEF）and prognosis improvement in patients with acute anterior myocardial infarction （AAMI）complicated hypoxemia after noninvasive mechanical ventilation therapy.Methods：A total of 60 patients with AAMI complicated hypoxemia,who were hospitalized in our hospital from Mar 2011 to Oct 2013,were divided into noninvasive ventilation group （n=28）and routine treatment group （n=32）according to number table.Dynamic change of BNP, LVEF and prognosis were observed and compared between two groups.Results：After treatment,BNP level and LVEF significantly improved in both groups （P〈0.05 all）,compared with routine treatment group,there was more significant reduction in BNP level [24h：（263.6±23.3）μmol/L vs.（126.2±21.9）μmol/L]and significant rise in LVEF [（40.6±13.1）% vs.（47.3±14.7）%]in noninvasive ventilation group after treatment （P〈0.01 both）;after 30d follow-up,there were significant rise in 6min walking distance （percentage of 426-550m,59.3% vs. 75.0%）,LVEF [（41.1±11.7）% vs.（49.4±12.5）%]and survival rate （90.6% vs.96.4%）,and significant reduction in rehospitalization rate （12.5% vs.7.1%）in noninvasive ventilation group,P〈0.01 all.Conclusion：Early noninvasive mechanical ventilation therapy can significantly improve cardiac function,exercise tolerance and short-term prognosis in patients with acute anterior myocardial infarction complicated hypoxemia.