有创-无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆ANP、NT-proBNP的影响

Effect of invasive-noninvasive sequential mechanical ventilation on plasma ANP and NT-proBNP in patients with severe pneumonia complicated with respiratory failure

目的探讨重症肺炎合并呼吸衰竭患者采用有创-无创序贯机械通气对患者血浆心钠肽(ANP)、B型氨基端利钠肽原(NT-proBNP)水平的影响。方法选择2016年4月至2018年3月在杞县中医院重症监护室(ICU)治疗的84例重症肺炎合并呼吸衰竭患者为研究对象,将患者以机械通气方式不同分为观察组(n=42)和对照组(n=42),观察组患者给予有创-无创序贯机械通气,对照组患者给予传统有创机械通气。对比分析两组患者呼吸频率(RR)、心率(HR)、血气指标、住院时间、住ICU时间、有创通气时间、机械通气总时间、炎症细胞因子及心损伤标志物水平、撤机成功率、呼吸机相关肺炎(VAP)情况及预后。结果治疗后,两组患者氧分压(Pa O2)和PH值明显上升(P<0.05),HR、RR及二氧化碳分压(Pa CO2)有明显下降(P<0.05),但两组比较无明显差异(P>0.05);观察组住院时间、住ICU时间、有创通气时间、机械通气总时间小于对照组的,差异有统计学意义(P<0.05);治疗后,观察组IL-4、IL-6、IL-10、TNF-α低于对照组,差异有统计学意义(P<0.05)。治疗后,观察组血浆心钠肽(ANP)、B型氨基端利钠肽原(NT-proBNP)、肌钙蛋白I(c TnI)低于对照组,差异有统计学意义(P<0.05);观察组撤机成功率83.3%,高于对照组的57.1%,呼吸机相关性肺炎(VAP)发生率9.5%、院内死亡率2.4%,低于对照组26.2%、11.9%,差异有统计学意义(P<0.05)。结论重症肺炎合并呼吸衰竭采用有创-无创序贯机械通气治疗,可改善患者血气状况,促进患者康复,并可抑制炎症反应,减轻心功能损伤,对患者预后有一定积极意义。

Objective To investigate the effects of invasive-nonin vasive sequential mechanical ventilation on plasma levels of ANP and NT-proBNP in patients with severe pneumonia complicated with respiratory failure. Methods 86 patients with severe pneumonia complicated with respiratory failure who were treated in the ICU of the Qi county Traditional Chinese Medicine Hospital from April 2016 to March 2018 were selected as subjects. The patients were divided into the observation group(n = 42) and the control group(n = 42) by mechanical ventilation. Patients in the observation group were given invasive-noninvasive sequential mechanical ventilation, and patients in the control group were given conventional invasive mechanical ventilation. Comparative analysis of RR、HR, blood gas index,hospitalization time,ICU time,invasive ventilation time,total mechanical ventilation time,inflammatory cytokines and heart damage markers, and the success rate of weaning, ventilator-associated pneumonia(VAP) and prognosis. Results After treatment, Pa02 and PH value of the two groups were significantly increased(P< 0.05), and the HR, RR and PaC02 were significantly decreased(P < 0.05),but there was no significant difference between the two groups(P > 0.05);hospitalization time, invasive ventilation time, total mechanical ventilation time of the observation group were lower than that of the control group, the difference was statistically significant(P < 0.05);after treatment,IL-4,IL-6,IL-10, TNF-α of the observation group were lower than that of the control group, the difference was statistically significant(P < 0.05). After treatment, the plasma ANP,NT-proBNP and cTnI were lower in the observation group than that of the control group, and the difference was statistically significant(P< 0.05). The success rate of the observation group was higher than that of the control group. The incidence of VAP and hospital mortality were lower than the control group, and the difference was statistically significant(P < 0.05). Conclusion Severe pneumonia combined with respiratory failure is treated with invasive-non-invasive sequential mechanical ventilation, which can improve the blood gas status of patients and promote the rehabilitation of patients. It can inhibit the inflammatory reaction and reduce the heart function damage. It has certain positive significance for the prognosis of patients.