双水平无创正压通气对急诊Ⅱ型呼吸衰竭并心衰患者NT-proBNP及hs-CRP的影响

Effect of bi-level noninvasive positive pressure ventilation on NT-proBNP and hs-CRP in patients with emergency typeⅡrespiratory failure and heart failure

目的探讨双水平无创正压通气(BiPAP)对急诊Ⅱ型呼吸衰竭合并心衰患者NT-proBNP及hs-CRP的影响。方法选择2019年3月至2019年9月于我院急诊科治疗的Ⅱ型呼衰合并心衰患者61例,按照随机数字表法将所有患者分为对照组31例及实验组30例。两组患者入院后均给予Ⅱ型呼衰合并心衰常规治疗,对照组在此基础上给予面罩吸氧治疗,而实验组则给予BiPAP治疗。分别比较患者治疗前(T1)及治疗后24 h(T2)、48 h(T3)时一般资料、动脉血气分析及心功能相关指标、血浆NT-proBNP及hs-CRP以及治疗过程中转为有创通气治疗人数之间的差异。并对患者进行12个月的随访,比较两组患者间死亡风险的差异。结果两组患者一般资料比较无显著差异(P>0.05);实验组患者治疗总有效率与对照组相比较显著较高(χ^2=6.318,P<0.05);实验组患者治疗后T2及T3时HR及BR与对照组比较显著较低,SpO2则显著较高(P<0.05)。实验组患者T2及T3时PCO2与对照组比较显著较低,pH、PaO2、LVEF及SV则显著较高(P<0.05)。实验组T2及T3时时NT-proBNP及hs-CRP值与对照组比较显著较低(P<0.05)。两组患者治疗过程中转为有创机械呼吸人数比较无显著差异(χ^2=2.074,P=0.149)。Log rank分析结果显示实验组的死亡风险较对照组显著较低(Log rankχ^2=4.563,P=0.034)。结论BiPAP能有效改善Ⅱ型呼吸衰竭并心衰患者呼吸功能及心功能情况,有效治疗上述疾病的同时还能改善患者1年内病死率。

Objective To investigate the effect of bi-level noninvasive positive pressure ventilation(BiPAP)on NT-proBNP and hs-CRP in the patients with typeⅡrespiratory failure and heart failure.Methods Sixty patients with typeⅡrespiratory failure and heart failure who were treated in the Emergency Department of our hospital from march 2019 to September 2019 were selected for this study.The patients were divided into a control group 31 cases and an experimental group 30 cases according to the random number table method.Both groups were treated with the conventional emergency treatment for typeⅡrespiratory failure and heart failure at the time of admission.The control group received mask oxygen therapy on the basis of this,while the experimental group received BiPAP treatment.The differences between the general data,the arterial blood gas analysis and the cardiac function-related indicators,plasma NT-proBNP and hs-CRP,and the number of the patients with invasive ventilation during the treatment were compared before treatment(T1)and 24 h(T2)and 48 h(T3)after treatment.The patients were followed up for 12 months,and then the difference in mortality between the two groups was compared.Results There was no significant difference in general information between the two groups(P>0.05).The total effective rate of the experimental group was significantly higher than that of the control group(χ^2=6.318 and P<0.05).At T2 and T3,the HR and BR were significantly lower and the SpO2 was significantly higher in the experimental group than the control group(P<0.05).At T2 and T3,the PCO2 was significantly lower and the PH,PaO2,LVEF and SV were significantly higher in the experimental group than the control group(P<0.05).At T2 and T3,the NT-proBNP and hs-CRP values in the experimental group were significantly lower than those of the control group(P<0.05).There was no significant difference in the number of patients with invasive mechanical respiration during the treatment between the two groups(χ^2=2.074 and P=0.149).Log rank analysis showed that the risk of death in the experimental group was significantly lower than that of the control group(Log rankχ^2=4.563 and P=0.034).Conclusion BiPAP can effectively improve the respiratory function and the cardiac function of the patients with typeⅡrespiratory failure and heart failure.It can effectively treat the above diseases and improve the mortality within 1 year.