经面罩双水平气道正压通气联合布地奈德雾化吸入治疗高原肺水肿的疗效及对患者心功能的影响

Therapeutic effect of mask bi-level positive airway pressure ventilation combined with budesonide nebulization inhalation in the treatment of high-altitude pulmonary edema and its impact on cardiac function of patients

目的探讨经面罩双水平气压通气(BiPAP)联合布地奈德雾化吸入治疗高原肺水肿(HAPE)的效果及对患者心功能的影响。方法选择2021年7月至2022年11月青海省果洛藏族自治州人民医院收治的60例HAPE患者进行研究,按随机数表法分为观察组和对照组,每组30例。对照组患者给予高流量面罩吸氧治疗,观察组患者给予BiPAP联合布地奈德雾化吸入治疗,两组均治疗3 d。治疗3 d后,比较两组患者的疗效及治疗情况(湿啰音消失时间、X线阴影持续时间、住院时间),同时比较两组患者治疗前后的血气指标[二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))]、肺功能指标[第1秒用力呼气容积占预计值百分比(FEV1%pred)、第1秒用力呼气容积占用力肺活量比值(FEV1/FVC)]及心功能指标[左室射血分数(LVEF)、肌酸激酶同工酶(CK-MB)、脑钠肽(BNP)]。结果观察组患者的治疗总有效率为96.67%,明显高于对照组的73.33%,差异有统计学意义(P<0.05);观察组患者的湿啰音消失时间、X线阴影持续时间、住院时间分别为(56.92±4.28)h、(78.29±6.11)h、(6.51±1.29)d,明显短于对照组的(76.17±4.51)h、(97.18±7.20)h、(11.31±2.05)d,差异均有统计学意义(P<0.05);治疗后,两组患者的PaCO_(2)均较治疗前降低,且观察组患者的PaCO_(2)为(46.92±5.21)mmHg,明显低于对照组的(51.28±4.98)mmHg,而PaO_(2)、FEV1%pred、FEV1/FVC均较治疗前升高,且观察组的上述指标分别为(75.29±5.09)mmHg、(50.91±4.14)%、(65.19±5.10)%,明显高于对照组的(66.18±4.99)mmHg、(45.28±4.72)%、(56.28±4.98)%,差异均有统计学意义(P<0.05);治疗后,两组患者的LVEF均较治疗前升高,且观察组患者的LVEF为(49.17±4.07)%,明显高于对照组的(42.38±3.75)%,而CK-MB、BNP水平均较治疗前降低,且观察组患者的CK-MB、BNP水平分别为(7.71±1.41)ng/L、(106.91±23.09)ng/L,明显低于对照组的(9.10±1.32)ng/L、(180.81±33.74)ng/L,差异均有统计学意义(P<0.05)。结论BiPAP联合布地奈德雾化吸入治疗HAPE的效果良好,可促进患者症状缓解,改善血气指标及心肺功能,具有临床应用价值。

Objective To investigate the efficacy of mask bi-level positive airway pressure ventilation(BiPAP)combined with budesonide nebulization inhalation in the treatment of high-altitude pulmonary edema(HAPE)and its impact on cardiac function in patients.Methods Sixty patients with HAPE admitted to the People's Hospital of Guoluo Tibetan Autonomous Prefecture of Qinghai from July 2021 to November 2022 were selected for the study.They were divided into two groups using a random number table method,with 30 patients in each group.Patients in the control group were treated with high-flow mask oxygen inhalation,while those in the observation group were treated with BiPAP combined with budesonide nebulization inhalation,both for 3 days.After treatment,the efficacy and treatment recovery status of the two groups(time of disappearance of wet rales,duration of X-ray shadow,and length of hospital stay)were compared,as well as the blood gas indicators[partial pressure of carbon dioxide(PaCO_(2))and arterial blood oxygen(PaO_(2))],pulmonary function indicators[percentage of forced expiratory volume in the first second to predicted value(FEV1%pred),ratio of forced expiratory volume in the first second to forced vital capacity(FEV1/FVC)],and cardiac function indicators[left ventricular ejection fraction(LVEF),creatine kinase isoenzyme(CK-MB),brain natriuretic peptide(BNP)].Results The total effective rate of treatment in the observation group was 96.67%,which was significantly higher than 73.33%in the control group(P<0.05);the disappearance time of wet rales,duration of X-ray shadows,and length of hospital stay in the observation group were(56.92±4.28)h,(78.29±6.11)h,and(6.51±1.29)d,which were significantly shorter than(76.17±4.51)h,(97.18±7.20)h,and(11.31±2.05)d in the control group;the differences were statistically significant(P<0.05).After treatment,the PaCO_(2)of both groups of patients decreased compared to those before treatment,and the PaCO_(2)of the observation group was(46.92±5.21)mmHg,which was significantly lower than(51.28±4.98)mmHg of the control group;PaO_(2),FEV1%pred,FEV1/FVC increased compared to those before treatment,and the indicators of the observation group were(75.29±5.09)mmHg,(50.91±4.14)%,(65.19±5.10)%,which were significantly higher than(66.18±4.99)mmHg,(45.28±4.72)%,(56.28±4.98)%of the control group;the differences were significant(P<0.05).After treatment,the LVEF of both groups of patients increased compared to those before treatment,and the LVEF of the observation group was(49.17±4.07)%,which was significantly higher than(42.38±3.75)%of the control group;the levels of CK-MB and BNP decreased compared to those before treatment,and the levels of the observation group were(7.71±1.41)ng/L and(106.91±23.09)ng/L,which were significantly lower than(9.10±1.32)ng/L and(180.81±33.74)ng/L of the control group;the differences were statistically significant(P<0.05).Conclusion The combination of BiPAP and budesonide nebulization inhalation is effective in treating HAPE,which can promote symptom relief,improve blood gas indicators and cardiopulmonary function,and has clinical application value.