双水平气道正压通气联合法舒地尔治疗CPHD合并Ⅱ型呼吸衰竭疗效观察

Therapeutic effects of bi level positive airway pressure ventilation combined with fasudil hydrochloride injection on CPHD complicated by type Ⅱ respiratory failure

目的观察双水平气道正压通气联合法舒地尔治疗慢性肺源性心脏病合并Ⅱ型呼吸衰竭的临床疗效,旨在为今后更有效抢救慢性肺源性心脏病合并Ⅱ型呼吸衰竭提供参考和借鉴。方法前瞻性选取2015年1月至2016年6月120例确诊为慢性肺源性心脏病合并Ⅱ型呼吸衰竭患者,采用随机数字表法将其分为2组,对照组行常规支持+双水平气道正压通气,观察组加用法舒地尔,比较2组心率、呼吸、mMRC评分、血气指标、肺通气功能、CRP和NT-proBNP水平以及肺动脉压变化情况。结果观察组呼吸、心率水平及mMRC评分改善情况较对照组更为显著(P<0.05);观察组pH、PaO_2、SaO_2水平增高程度和PaCO_2水平降低程度较对照组更为明显(P<0.05);FEV1%、FEV1/FVC水平增高程度较对照组更为显著(P<0.05);观察组CRP、NT-proBNP水平降低程度较对照组更显著(P<0.05);观察组PASP、PADP、MPAM水平改善情况明显优于对照组(P<0.05)。结论法舒地尔联合双水平气道正压通气可早期明显改善肺源性心脏病伴Ⅱ型呼吸衰竭患者肺通气功能,纠正呼吸衰竭,同时还可减轻机体的炎性反应并降低肺动压力,具有广阔的应用前景。

Objective To observe the therapeutic effects of Bi level positive airway pressure ventilation combined with fasudil hydrochloride injection on chronic pulmonary heart disease （ CPHD） complicated by type II respiratory failure in order to provide reference for the more effective treatment of CPHD complicated by type II respiratory failure in the future. Methods A total of 120 patients with CPHD complicated by type II respiratory failure who were treated in our hospital from January 2015 to June 2016 were randomly divided into control group and observation group. The patients in control group were treated by routine supportive therapy＋bi level positive airway pressure ventilation,however,the patients in observation group, on the basis of control group, were treated by fasudil hydrochloride injection. The heart rate,respiration,mMRC score,blood gas indexes,pulmonary ventilation function, levels of CRP and NT-proBNP as well as pulmonary artery pressure changes were observed and compared between two groups. Results The improvement status of breathing, heart rate and mMRC score in observation group was more obvious than that in control group （P 〈0. 05）. The levels of pH,PaO2,SaO2 and PaCO2 in observation group were significantly higher than those in control group （P〈0. 05）,moreover,the levels of FEV1% and FEV1/FVC were significantly higher than those in control group （P 〈0. 05）. However the levels of CRP and NT-proBNP in observation group were significantly lower than those in control group （P〈0. 05）. The improvement status of PASP,PADP, MPAM in observation group was superior to that in control group （P〈0. 05）. Conclusion The fasudil hydrochloride injection combined with bi level positive airway pressure ventilation can significantly improve pulmonary ventilation function of patients with CPHD complicated by type II respiratory failure, and can correct respiratory failure, meanwhile, which can alleviate inflammatory reaction and reduce pulmonary artery pressure,thus, which has broad application prospects.