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目的探讨行机械通气治疗慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)急性加重期患者N-末端B型脑钠肽前体(N-terminal probraintype natriuretic peptide,NT-ProBNP)水平变化及其临床意义。方法 45例COPD急性加重期患者在抗感染、解除气道痉挛、祛痰等常规治疗基础上,均给予无创机械通气治疗,采用双水平气道正压(bi-level positive airway pressure,BiPAP)模式;呼气未正压为0.392～0.784kPa,辅助通气起始压力1.00～1.47kPa,并根据患者病情调整吸入氧浓度、压力;观察治疗前及治疗3,12h后患者血浆NT-proBNP水平、呼吸频率、心率、平均动脉压、pa(CO2)等指标。结果治疗3,12h后,患者呼吸频率、心率、平均动脉压、pa(CO2)、NT-proBNP水平均较治疗前降低(P<0.05),pa(O2)较治疗前增高(P<0.05);治疗12h后各指标水平与治疗3h后比较差异有统计学意义(P<0.05)。结论缺氧可能是心功能正常的COPD急性加重期患者NT-proBNP水平升高的主要原因。
Objective To investigate the changes of N-terminal probraintype natriuretic peptide (NT-ProBNP) in patients with acute obstructive pulmonary disease (COPD) undergoing mechanical ventilation and its clinical significance significance. Methods Forty-five patients with acute exacerbation of COPD were given non-invasive mechanical ventilation on the basis of routine anti-infection, relieving airway spasm and expectorant. Bi-level positive airway pressure (BiPAP) ; Exhaled non-positive pressure 0.392 ~ 0.784kPa, auxiliary ventilation initial pressure 1.00 ~ 1.47kPa, and adjust the inhaled oxygen concentration and pressure according to the patient’s condition; observed before treatment and after treatment 3,12h plasma NT-proBNP levels, Frequency, heart rate, mean arterial pressure, pa (CO2) and other indicators. Results The respiratory rate, heart rate, mean arterial pressure, pa (CO2) and NT-proBNP in patients after treatment were lower than those before treatment (P <0.05) ; The level of each index after 12 hours of treatment was significantly different from that of 3 hours after treatment (P <0.05). Conclusion Hypoxia may be the main reason for the elevation of NT-proBNP level in patients with normal cardiac function during acute exacerbations of COPD.