无创呼吸机联合重组人脑利钠肽治疗急性心力衰竭合并严重呼吸困难患者的临床疗效

Clinical Efficacy of Noninvasive Ventilator Combined with Recombinant Human Brain Natriuretic Peptide in the Treatment of Acute Heart Failure Patients with Severe Dyspnea

【目的】探讨无创呼吸机联合重组人脑利钠肽治疗急性心力衰竭合并重度呼吸障碍患者的临床效果。【方法】选取2018年1月至2023年1月在安庆市立医院重症医学科接受治疗的急性心力衰竭合并严重呼吸困难的84例患者,按照随机数字表法分为观察组(无创呼吸机联合重组人脑利钠肽治疗)和对照组(采用无创呼吸机治疗),每组42例。比较两组患者心功能[左心室射血分数(LVEF)、左心室收缩末内径(LVESD)、左心室舒张末内径(LVEDD)、中心静脉压(CVP)、速度时间积分(VTI)]、肺部B线积分、血气指标[动脉血二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))、动脉血氧饱和度(SpO_(2))]、心肌损伤标志物[心肌肌钙蛋白T(cTnT)、cTnI和脑钠肽(BNP)]、呼吸困难指数[慢性阻塞性肺疾病评分(mMRC)];采用Pearson分析患者心功能指标和mMRC的相关性。【结果】治疗后,观察组LVESD、LVEDD、肺部B线积分、CVP、PaCO_(2)、心肌损伤标志物水平和mMRC均低于对照组,LVEF、VTI、SaO_(2)、PaO_(2)、SpO_(2)高于对照组(P<0.05)。Pearson分析结果显示:mMRC与LVESD、LVEDD、CVP呈正相关,与LVEF呈负相关(P<0.05)。【结论】AHF合并严重呼吸困难患者进行无创呼吸机与重组人脑利钠肽联合治疗,可降低患者心脏和呼吸肌的负担,并优化心肺功能与气体交换。

【Objective】To investigate the clinical effect of noninvasive ventilator combined with recombinant human brain natriuretic peptide in the treatment of acute heart failure complicated with severe respiratory disorders.【Methods】A total of 84 patients with acute heart failure combined with severe dyspnea who were treated in the Intensive Care Department of the Anqing Municipal Hospital from January 2018 to January 2023 were selected and divided into the observation group(noninvasive ventilator combined with recombinant human brain natriuretic peptide treatment)and the control group(noninvasive ventilator treatment)according to random number table method,with 42 cases in each group.The two groups were compared in terms of cardiac function[left ventricular ejection fraction(LVEF),left ventricular end-systolic diameter(LVESD),left ventricular end-diastolic diameter(LVEDD),central venous pressure(CVP),velocity time integral(VTI)],lung B-line integral and blood gas index(PaCO_(2)),blood oxygen saturation(SaO_(2)),partial arterial oxygen pressure(PaO_(2)),arterial oxygen saturation(SpO_(2)),myocardial injury markers[cardiac troponin T(cTnT),cTnI and brain natriuretic peptide(BNP)],dyspnea index[Chronic obstructive Pulmonary disease score(mMRC)];The correlation between cardiac function indexes and mMRC was analyzed by Pearson.【Results】After treatment,LVESD,LVEDD,lung B-line score,CVP,PaCO_(2),myocardial injury markers and mMRC in observation group were lower than those in control group,while LVEF,VTI,SaO_(2),PaO_(2) and SpO_(2) were higher than those in control group(P<0.05).The results of Pearson analysis showed that mMRC was positively correlated with LVESD,LVEDD and CVP,and negatively correlated with LVEF(P<0.05).【Conclusion】The combination of noninvasive ventilator and recombinant human brain natriuretic peptide therapy in patients with severe dyspnea with AHF can reduce the burden on the heart and respiratory muscles,and optimize the cardiopulmonary function and gas exchange.