持续气道正压通气水平对慢性阻塞性肺疾病并肺动脉高压机械通气患者脑钠肽的影响

Effect of continuous positive end expiratory pressure ventilation level on brain natriuretic peptide in patients with chronic obstructive pulmonary disease and pulmonary hypertension

目的探讨持续气道正压通气(PEEP)水平对慢性阻塞性肺疾病(COPD)并肺动脉高压机械通气患者脑钠肽(BNP)的影响。方法选取2016年5月~2018年5月江西省瑞金市人民医院收治的100例COPD并肺动脉高压机械通气患者作为研究对象,按照PEEP水平的不同将患者分为两组,分别为PEEP低水平组(3~4 cmH2O,n=50)和PEEP高水平组(6~7 cmH2O,n=50)。比较两组患者的肺动脉压、BNP、动脉血二氧化碳分压(PaCO2)、动脉血氧分压(PaO2)水平、pH值、肺功能指标[第1秒用力呼气容积(FEV1)、FEV1百分比(FEV1%)、FEV1与第1秒呼气容积同肺活量(FVC)之间的比值(FEV1/FVC)]等。结果治疗前,两组患者的肺动脉压、BNP、PaCO2、PaO2水平、pH值比较,差异无统计学意义(P>0.05)。治疗后,PEEP低水平组患者的肺动脉压、BNP、PaCO2低于PEEP高水平组,PaO2高于PEEP高水平组,差异有统计学意义(P<0.05);PEEP低水平组患者的pH值与PEEP高水平组比较,差异无统计学意义(P>0.05)。治疗后,两组患者的肺动脉压、BNP、PaCO2水平均低于治疗前,PaO2水平、pH值高于治疗前,差异有统计学意义(P<0.05)。治疗前,两组患者的FEV1、FEV1%、FEV1/FVC比较,差异无统计学意义(P>0.05)。治疗后,两组患者的FEV1、FEV1%、FEV1/FVC均高于治疗前,差异有统计学意义(P<0.05);PEEP低水平组患者治疗后的FEV1、FEV1%、FEV1/FVC均高于PEEP高水平组,差异有统计学意义(P<0.05)。结论COPD并肺动脉高压患者的通气治疗中,有创机械通气效果较好,但是要根据患者的实际情况来选择PEEP水平。

Objective To investigate the effect effect of continuous positive end expiratory pressure ventilation(PEEP)level on brain natriuretic peptide(BNP)in patients with chronic obstructive pulmonary disease(COPD)and pulmonary hypertension.Methods A total of 100 patients with COPD and pulmonary hypertension who underwent mechanical ventilation in our Ruijin People′s Hospital,Jiangxi Province,from May 2016 to May 18,2016 were selected as subjects,and divided into two groups according to the level of PEEP,PEEP low level group(3-4 cmH2O,n=50)and PEEP high level group(6-7 cmH2O,n=50),respectively.Pulmonary arterial pressure,BNP,arterial partial pressure of carbon dioxide(PaCO2),arterial partial pressure of oxygen(PaO2),pH value,pulmonary function indicators(FEV1 forced expiratory volume at the first second[FEV1],FEV1 percentage[FEV1%],ratio of FEV1 and 1st second expiratory volume to lung capacity[FVC][FEV1/FVC])were compared between the two groups.Results Before treatment,there were no significant differences in pulmonary artery pressure,BNP,PaCO2,PaO2 levels and pH value between the two groups(P>0.05).After treatment,pulmonary arterial pressure,BNP and PaCO2 in the PEEP low level group were lower than those in the PEEP high level group,and PaO2 was higher than that in the PEEP high level group,the differences were statistically significant(P<0.05).There was no significant difference in pH value between PEEP low level group and PEEP high level group(P>0.05).The levels of pulmonary artery pressure,BNP and PaCO2 of patients in the PEEP low level group and PEEP high level group were lower than those before treatment,the level of PaO2 and pH value were higher than those before treatment,the differences were statistically significant(P<0.05).Before treatment,there were no significant differences in FEV1,FEV1%,FEV1/FVC between the two groups(P>0.05).After treatment,the FEV1,FEV1%,FEV1/FVC of patients in the PEEP low level group and PEEP high level group were higher than those before treatment,the differences were statistically significant(P<0.05).The FEV1,FEV1%,FEV1/FVC of patients in the PEEP low level group were higher than those in the PEEP high level group,and the differences were statistically significant(P<0.05).Conclusion Invasive mechanical ventilation is better in patients with COPD and pulmonary hypertension.However,PEEP should be selected according to the actual situation of patients.