NT-pro BNP水平与CVP监测对COPD机械通气患者的撤机成功率的影响

Effect of NT-proBNP and CVP monitoring on the success rate of withdrawal of COPD patients with mechanical ventilation

目的研究探讨N端脑钠肽前体(NT-proBNP)水平与中心静脉压(CVP)监测,对慢性肺阻塞性肺疾病(COPD)机械通气患者的撤机成功率的影响。方法选取2015年1月-2017年12月在我院进行有创呼吸机辅助通气治疗的COPD患者200例为研究对象,所有患者均进行机械通气治疗,在机械通气时对患者的NT-proBNP和CVP进行监测,依据监测结果分为:观察组(n=102),即NT-proBNP≤500pg/mL,CVP≤15cmH2O;对照组(n=98),即NT-proBNP>500pg/mL,CVP>15cmH2O。对两组患者的撤机成功率进行统计比较,并对两组患者撤机后NT-proBNP、CVP、呼吸频率、用力肺活量等指标进行检测对比。结果(1)两组患者性别、年龄、动脉血pH值、PaO2、PaCO2分压等基础资料比较差异无统计学意义(P>0.05)。(2)观察组患者撤机成功率为87.25%(89/102),对照组患者撤机成功率为68.37%(67/98),组间比较差异有统计学意义(P<0.05)。(3)观察组患者撤机后的NT-proBNP、CVP、呼吸频率均低于对照组,用力肺活量则高于对照组,组间比较差异有统计学意义(P<0.05)。结论在COPD患者机械通气治疗中通过NT-proBNP、CVP水平进行联合监测对机械通气患者的撤机结局有一定的预测作用,可作为撤机的辅助判断指标。

Objective To investigate the effect of monitoring N terminal pro brain natriuretic peptide(NT-proBNP)level and central venous pressure(CVP)on the successful rate of mechanical ventilation in patients with chronic obstructive pulmonary disease(COPD).Methods From January 2015 to December 2017 in our hospital,200 COPD patients received invasive mechanical ventilation were taken as the research objects.All patients were treated with mechanical ventilation,and their NT-pro BNP and CVP were monitored.According to the monitoring results,they were divided into the observation group(n=102,NT-pro BNP≤500pg/mL,CVP≤15cmH 2O)and the control group(n=98,NT-proBN P>500pg/mL,CV P>15cm H2O).The success rate of weaning in the two groups was statistically compared.The indexes of NT-proBNP,CVP,respiratory rate and cardiac output were compared between the two groups after weaning.Results(1)There was no significant difference in gender,age,pH value of arterial blood,PaO 2 and PaCO 2 partial pressure between the two groups(P>0.05).(2)The success rate of weaning in the observation group was 87.25%(89/102),and the success rate of weaning in the control group was 68.37%(67/98)(P<0.05).(3)The value of NT-pro BNP,CVP and respiratory rate of the observation group were lower than those of the control group,and the cardiac output was higher than that of the control group.The difference between the two groups was statistically significant(P<0.05).Conclusion The combined monitoring of NT-proBNP and CVP level can predict the weaning outcome of patients with mechanical ventilation in COPD patients,which can be used as an assistant index for weaning.