无创正压通气治疗COPD合并肺源性心脏病的疗效及对血浆C反应蛋白和脑钠素水平的影响

Noninvasive positive pressure ventilation in treatment of COPD with pulmonary heart disease and its relation to plasma C-reactive protein and brain natriuretic peptide

目的探讨无创正压通气对慢性阻塞性肺疾病(COPD)合并肺源性心脏病的疗效和对患者血浆C反应蛋白(CRP)和脑钠素(BNP)水平的影响。方法将2012年1月到2014年1月收治的120例COPD急性加重期合并肺源性心脏病患者随机分为观察组(60例)和对照组(60例),对照组给予常规治疗,观察组在此基础上给予无创正压通气治疗。治疗前和治疗3d后分别进行动脉血气分析,比较患者血pH值、PaO_2、PaCO_2和动脉血氧饱和度(SaO_2)在治疗前后的改变,并监测治疗前后血浆CRP和BNP水平的改变。结果治疗3d后,两组患者的pH值、PaO_2、SaO_2均较治疗前明显升高,PaCO_2较治疗前明显降低,而观察组患者治疗后的动态血气分析指标的改善情况明显优于对照组,均有统计学差异(均P<0.05)。两组患者的血浆CRP和BNP水平均较治疗前明显降低,而观察组患者治疗后的血浆CRP和BNP水平明显低干对照组,均有统计学差异(均P<0.05)。结论无创正压通气治疗COPD合并肺源性心脏病,能够有效改善血气指标,提高SaO_2和PaO_2,同时降低血浆CRP和BNP的水平,值得在临床推广应用。

Objective To investigate noninvasive positive pressure ventilation （NPPV） in treatment of chronic obstruc- tive pulmonary disease （COPD） with pulmonary heart disease and its relation of plasma C-reactive protein （CRP） and brain natriuretic peptide（BNP）. Methods One hundred and twenty COPD patients with pulmonary heart disease admitted in our hos- pital from January 2012 to January 2014 were randomly divided into NPPV group （n=60） and control group （n=60）. Conventional treatment was given to both groups, while NPPV group received additional noninvasive positive pressure ventilation. The blood gas was analyzed before and 3d after treatment, the pH, arterial oxygen pressure （PaO2）, arterial carbon dioxide partial pressure （PaCO2） and arterial oxygen saturation （SaO2） changes were compared before and after treatment in both groups. Plasma CRP and BNP levels were measured before and after treatment. Results Three days after treatment, the pH, PaO2, SO2 were signifi- cantly higher and PaCO2 was significantly lower than before treatment in both groups; the dynamic improvement in blood gas analysis of the NPPV group was significantly better than that of control group （P〈0.05）. Compared to pretreatment the plasma CRP and BNP levels were significantly lower after treatment in both groups; the post-treatment BNP plasma CRP levels of NPPV group were significantly lower than those of contro~ group （P〈0.05）. Conclusion Noninvasive positive pressure ventilation in treatment of COPD patients with pulmonary heart disease can improve blood indicators, arterial oxygen saturation and blood pressure, which is associated with the decrease of plasma CRP and BNP.