双水平气道正压通气对老年慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者血浆N-端脑利钠肽前体水平的影响

Effect of bilevel positive airway pressure ventilation on plasma level of N-terminal pro-brain natriuretic peptide in patients with chronic pulmonary heart disease and hypercapnic respiratory failure

目的 探讨血浆N端脑利钠肽前体（NT proBNP）在慢性肺源性心脏病（CPHD）合并Ⅱ型呼吸衰竭中的作用及双水平气道正压（BiPAP）对其的影响. 方法 将80例CPHD合并Ⅱ型呼吸衰竭患者分为常规治疗组和BiPAP通气组各40例,分别在治疗前及治疗120 h后进行慢性阻塞性肺疾病患者自我评估测试（CAT）、急性生理与慢性健康状况评分Ⅱ（APACHEⅡ）和血气分析,以电化学发光法检测血浆NT-proBNP水平. 结果 CPHD合并Ⅱ型呼吸衰竭患者治疗前血浆NT-proBNP与CAT评分（r=0.506,P=0.002）、APACHEⅡ评分（r=0.603,P=0.003）和PaCO2（r=0.539,P＝0.003）均呈正相关,与PaO2均呈负相关（r=-0.465,P=0.014）.与治疗前比较,两组患者治疗120 h后CAT评分、APACHEⅡ评分、血氧分压（PaO2）和血二氧化碳分压（PaCO2）均有明显改善;且与常规治疗组比较,BiPAP通气治疗能更明显改善APACHEⅡ评分（t=5.55,p＝0.002）、提高PaO2（t=5.92,P＝0.001）及降低PaCO2（t=4.12,P=0.000）.常规治疗组和BiPAP通气组治疗120-h血浆NT-proBNP分别为（341.2±107.6）ng/L和（273.3±82.2） ng/L,均较治疗前（823.8±149.0）ng/L和（832.7±163.0）ng/L显著下降（t＝21.72、28.19,均P=0.000）;且与常规治疗组比较,BiPAP通气组治疗120 h后血浆NT-proBNP下降更为显著（t=4.17,P＝0.002）.结论 血浆NT-proBNP水平能反映CPHD合并Ⅱ型呼吸衰竭患者病情的严重程度;BiPAP通气治疗能降低CPHD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平,是治疗CPHD合并Ⅱ型呼吸衰竭的有效手段.

Objective To investigate the effect of bilevel positive airway pressure （BiPAP） ventilation on N terminal pro-brain natriuretic peptide （N proBNP） in patients with chronic pulmonary heart disease （CPHD） and hypercapnic respiratory failure.Methods Eighty patients with CPHD and hypercapnic respiratory failure were randomized into the conventional group （n=40） and BiPAP ventilation group （n=40）.The COPD assessment test （CAT） score,APACHE Ⅱ score,arterial blood gas were measured and plasma level of N proBNP was detected by electrochemiluminescence immunoassay before and 120 h after treatment.The correlations of plasma N-proBNP levels with CAT scores,APACHE Ⅱ scores,levels of PaO2 and PaCO2 were analyzed.Results The plasma NT-proBNP level had positive correlations with PaCO2 level （r=0.539,P =0.003）,CAT score （r＝0.506,P＝0.002,APACHEⅡ score （r=0.603,P=0.003）,and had negative correlation with PaO2 level （r=-0.465,P=0.014） in the patients with CPHD and hypercapnic respiratory failure before treatment.Compared with pre-treatment,the scores of CAT and APACHE Ⅱ,the levels of PaO2 and PaCO2 were significantly improved 120 h after treatment.The improvements in APACHE Ⅱ,PaO2 and PaCO2 were more obviously significant in BiPAP ventilation group than in conventional group （t=5.55,5.92,4.12,respectively,P=0.002,0.001 and 0.000）.The plasma levels of NT proBNP in both conventional and BiPAP ventilation groups were significantly descended 120 h after treatment than pre-treatment [（341.2±107.6） ng/L vs.（823.8±149.0） ng/L,（273.3±82.2） ng/L vs.（832.7± 163.0） ng/L,t=21.72,28.19,both P＜0.001],and the decrease of NT-proBNP level was more significantly in BiPAP ventilation group than in conventional group （t=4.17,P=0.002）.Conclusions Plasma NT-proBNP level can reflect the severity of chronic pulmonary heart disease combined with hypercapnic respiratory failure.BiPAP ventilation can decrease the plasma level of NT proBNP in patients with CPHD and hypercapnic respiratory failure,which is an effective treatment for chronic pulmonary heart disease combined with hypercapnic respiratory failure.