无创正压通气(BiPAP)在治疗顽固性心力衰竭患者中的临床研究

Clinical Study of Non-invasive Positive Pressure Ventilation(Bi PAP)Role in the Treatment of Patients with Refractory Heart Failure

目的探讨无创正压通气(Bi PAP)在顽固性心力衰竭患者中的治疗作用。方法收集60例顽固性心力衰竭患者,随机分为Bi PAP呼吸机组30例,常规吸氧组30例。将住院治疗结果分为显效,有效,无效,死亡4类,分析两组患者治疗效果的差异;并在入院后当日、住院10 d、出院后1个月分别检测血氧饱和度(Sa O2),脑尿钠肽(BNP),部分神经内分泌指标,包括肾素活性(PRA)、血管紧张素Ⅱ(AngⅡ)、醛固酮(ALD)、肾上腺素(E)及去甲肾上腺素(NE),同时利用超声心动图检测其心室结构及功能,对两组患者的上述指标进行对比研究分析。结果 Bi PAP呼吸机组有效26例,无效3例,死亡1例,总有效率86.67%,病死率3.33%;常规吸氧组有效18例,无效8例,死亡6例,总有效率60%,病死率13.33%。两组比较有效率有显著性差异(P<0.05,χ2=4.043,P=0.044);病死率有显著性差异(P<0.05);两组患者在脑尿钠肽(BNP)、部分神经内分泌指标、心室结构及功能变化方面有显著性差异(P<0.05)。结论 Bi PAP呼吸机治疗顽固性心力衰竭患者疗效显著,可明显降低近期病死率,降低脑尿钠肽(BNP)、部分神经内分泌指标浓度、改善心肌重塑及心功能。

Objective To investigate non-invasive positive pressure ventilation（Bi PAP）in the role of therapy in patients with refractory heart failure. Methods 60 patients with refractory heart failure patients, randomly divided into Bi PAP breathing machine in 30 cases, conventional oxygen sets of 30 case. Inpatient treatment outcomes are divided into having an effect, valid, invalid, died in four groups, analysis of two groups of patients with the treatment effect difference; And to measure the plasma levels of saturation of blood oxygen（Sa O2）, several neuroendocrine factors including plasma renin activity（PRA）, aldosterone（ALD）,angiotensinⅡ（AngⅡ）, norepinephrine（NE）and epinephrine（E）. While detection of left ventricular structure and function using echocardiography. Finally, statistics was token to analysis the data. Results In Bi PAP group, there were 26 cases improved, invalid in 3 cases, 1 death cases, efficiency rate was 86.67%, Mortality 3.33%; and in oxygen group, there were 18 cases improved, 8 inefficacy, 6 deaths in the same time, efficiency rate was 60%, mortality 13.33%. There were significant difference in efficiency between the two groups（P〈0.05）, more efficient to have significant differences in the two groups（P〈 0.05, Chi-square values 4.043, P =0.044）, a significant difference in mortality（P 〈0.05）; Two groups of patients with brain natriuretic peptide（BNP）, part of the neuroendocrine system indicators, significant differences in changes of left ventricular structure and function（P〈0.05）. Conclusion The patients with refractory heart failure have a high mortality, effect of Bi PAP breathing machine therapy in patients with refractory heart failure significantly, can significantly reduce mortality, Bi PAP can reducing brain natriuretic peptide（BNP）, part of the neuroendocrine index, improved cardiac remodeling and cardiac function.