PEEP对ARDS合并心力衰竭患者的疗效及对BNP水平的影响

Therapeutic effect of PEEP on patients with ARDS complicated heart failure and its impact on BNP level

目的:观察呼气末正压通气(PEEP)对急性呼吸窘迫综合征(ARDS)合并心力衰竭(HF)患者的疗效,及对脑钠肽(BNP)水平的影响。方法:2014年3月~2019年3月于本院行机械通气治疗的120例ARDS+HF患者被随机均分为常规治疗组和PEEP组(在常规治疗的基础上接受PEEP治疗),两组均治疗72h。观察比较两组治疗前后呼吸频率(RR)、心率、肺顺应性、动脉血氧分压(PaO_(2))、血氧饱和度(SpO_(2))、氧合指数(PaO_(2)/FiO_(2))、急性生理与慢性健康II(APACHE II)评分、血浆BNP水平。结果:与常规治疗组比较,PEEP组治疗72h后RR[(18.19±1.69)次/min比(15.85±1.57)次/min]、心率[(80.79±7.85)次/min比(72.90±8.81)次/min]、APACHE II评分[(17.03±2.54)分比(13.33±1.98)分]和血浆BNP水平[(885.51±142.16)ng/L比(637.85±107.85)ng/L]降低更显著,肺顺应性[(42.49±3.31)cmH_(2)O比(47.72±4.55)cmH_(2)O]、PaO_(2)[(65.55±4.22)mmHg比(89.33±6.61)mmHg]、SpO_(2)[(83.95±12.59)%比(97.01±18.10)%]、PaO_(2)/FiO_(2)[(223.91±32.73)mmHg比(328.48±14.46)mmHg]升高更显著,P均=0.001。结论:在急性呼吸窘迫综合征合并心力衰竭患者中行呼气末正压通气可显著提高疗效,降低患者脑钠肽水平,改善其心肺功能指标。

Objective:To observe therapeutic effect of positive end expiratory pressure(PEEP)on patients with acute respiratory distress syndrome(ARDS)complicated heart failure(HF),and its impact on level of brain natriuretic peptide(BNP).Methods:A total of 120 ARDS+HF patients,who received mechanical ventilation in our hospital from Mar 2014 to Mar 2019,were randomly and equally divided into routine treatment group and PEEP group(received PEEP based on routine treatment),both groups were treated for 72h.Respiratory rate(RR),heart rate,pulmonary compliance,partial pressure of oxygen in artery(PaO_(2)),saturation of arterial blood oxygen(SpO_(2)),oxygenation index(PaO_(2)/FiO_(2)),score of acute physiology and chronic health evaluation(APACHE)II and plasma BNP level were observed and compared between two groups before and after treatment.Results:Compared with routine treatment group on 72h after treatment,there were significant reductions in RR[(18.19±1.69)times/min vs.(15.85±1.57)times/min],heart rate[(80.79±7.85)beats/min vs.(72.90±8.81)beats/min],APACHE II score[(17.03±2.54)scores vs.(13.33±1.98)scores]and plasma BNP level[(885.51±142.16)ng/L vs.(637.85±107.85)ng/L],and significant rise in pulmonary compliance[(42.49±3.31)cmH 2O vs.(47.72±4.55)cmH 2O],PaO_(2)[(65.55±4.22)mmHg vs.(89.33±6.61)mmHg],SpO 2[(83.95±12.59)%vs.(97.01±18.10)%],PaO_(2)/FiO_(2)[(223.91±32.73)mmHg vs.(328.48±14.46)mmHg]in PEEP group,P=0.001 all.Conclusion:Positive end expiratory pressure can significantly improve therapeutic effect,reduce BNP level and improve cardiopulmonary function in ARDS+HF patients.