无创机械通气治疗慢性阻塞性肺疾病急性加重并肺源性心脏病的疗效及对血浆C反应蛋白和B型尿钠肽水平的影响

Effect of Noninvasive Mechanical Ventilation on Acute Exacerbation of Chronic Obstructive Pulmonary Diseases Complicated with Pulmonary Heart Disease and Its Impact on Plasma Levels of CRP and BNP

目的探讨无创机械通气治疗慢性阻塞性肺疾病急性加重(AECOPD)并肺源性心脏病(肺心病)的疗效及对血浆C反应蛋白(CRP)和B型尿钠肽(BNP)水平的影响。方法选择2011年1月—2013年1月于都县人民医院收治的AECOPD并肺心病患者154例,将其随机分为对照组和观察组,各77例。对照组患者给予常规对症支持治疗,观察组患者在对照组基础上给予无创机械通气治疗,比较两组患者气促/胸闷、嗜睡及心率加快改善率,同时测定治疗前后血气分析指标(PaO2、PaCO2、SpO2)及血浆CRP、BNP水平。结果观察组患者气促/胸闷、嗜睡及心率加快改善率均高于对照组(P<0.05)。治疗前两组患者PaO2、PaCO2、SpO2及血浆CRP和BNP水平比较,差异无统计学意义(P>0.05);治疗后观察组患者PaO2和SpO2高于对照组,PaCO2及血浆CRP和BNP水平低于对照组(P<0.05)。结论无创机械通气能有效改善AECOPD并肺心病患者临床症状及血气分析指标,降低患者血浆CRP、BNP水平。

Objective To investigate effect of noninvasive mechanical ventilation on acute exacerbation of chronic ob- structive pulmonary diseases（AECOPD）complicated with pulmonary heart disease and its impact on plasma levels of CRP and BNP. Methods From January 2011 to January 2013,154 AECOPD patients complicated with pulmonary heart disease were se- lected and divided into control group and observation group,each of 77 cases. Both groups given conventional symptomatic sup- portive treatment,and observation group given extra noninvasive mechanical ventilation. Improvement rate of anhelation/ chest dis- tress,somnolence and increased heart rate were compared between the two groups,blood gas analysis index including PaO2 , PaCO2 ,SpO2 and plasma levels of CRP and BNP were detected before and after treatment. Results The improvement rate of anhelation / chest distress,somnolence and increased heart rate of observation group was higher than that of control group,respec- tively（P 〈 0. 05）. There was no significant differences of PaO2 ,PaCO2 ,SpO2 and plasma levels of CRP and BNP between the two groups before treatment,but PaO2 ,SpO2 of observation group were higher,PaCO2 ,plasma levels of CRP and BNP were lower than those of control group（P 〈 0. 05）. Conclusion Noninvasive mechanical ventilation can effectively improve the clin- ical symptoms and blood gas analysis index,reduce the plasma levels of CRP and BNP.