双水平无创正压通气对急诊Ⅱ型呼吸衰竭并心衰患者NT-proBNP及hs-CRP的影响

doi:10.3877/cma.j.issn.1674-6902.2020.02.022

目的

探讨双水平无创正压通气(BiPAP)对急诊Ⅱ型呼吸衰竭合并心衰患者NT-proBNP及hs-CRP的影响。

方法

选择2019年3月至2019年9月于我院急诊科治疗的Ⅱ型呼衰合并心衰患者61例，按照随机数字表法将所有患者分为对照组31例及实验组30例。两组患者入院后均给予Ⅱ型呼衰合并心衰常规治疗，对照组在此基础上给予面罩吸氧治疗，而实验组则给予BiPAP治疗。分别比较患者治疗前(T₁)及治疗后24 h(T₂)、48 h(T₃)时一般资料、动脉血气分析及心功能相关指标、血浆NT-proBNP及hs-CRP以及治疗过程中转为有创通气治疗人数之间的差异。并对患者进行12个月的随访，比较两组患者间死亡风险的差异。

结果

两组患者一般资料比较无显著差异(P>0.05)；实验组患者治疗总有效率与对照组相比较显著较高(χ²＝6.318，P<0.05)；实验组患者治疗后T₂及T₃时HR及BR与对照组比较显著较低，SpO₂则显著较高(P<0.05)。实验组患者T₂及T₃时PCO₂与对照组比较显著较低，pH、PaO₂、LVEF及SV则显著较高(P<0.05)。实验组T₂及T₃时时NT-proBNP及hs-CRP值与对照组比较显著较低(P<0.05)。两组患者治疗过程中转为有创机械呼吸人数比较无显著差异(χ²＝2.074，P＝0.149)。Log rank分析结果显示实验组的死亡风险较对照组显著较低(Log rank χ²＝4.563，P＝0.034)。

结论

BiPAP能有效改善Ⅱ型呼吸衰竭并心衰患者呼吸功能及心功能情况，有效治疗上述疾病的同时还能改善患者1年内病死率。

关键词: 双水平无创正压通气, Ⅱ型呼吸衰竭, 心力衰竭, NT-proBNP, hs-CRP

Objective

To investigate the effect of bi-level noninvasive positive pressure ventilation (BiPAP) on NT-proBNP and hs-CRP in the patients with type Ⅱ respiratory failure and heart failure.

Methods

Sixty patients with type Ⅱ respiratory failure and heart failure who were treated in the Emergency Department of our hospital from march 2019 to September 2019 were selected for this study. The patients were divided into a control group 31 cases and an experimental group 30 cases according to the random number table method. Both groups were treated with the conventional emergency treatment for type Ⅱ respiratory failure and heart failure at the time of admission. The control group received mask oxygen therapy on the basis of this, while the experimental group received BiPAP treatment. The differences between the general data, the arterial blood gas analysis and the cardiac function-related indicators, plasma NT-proBNP and hs-CRP, and the number of the patients with invasive ventilation during the treatment were compared before treatment (T₁) and 24 h (T₂) and 48 h (T₃) after treatment. The patients were followed up for 12 months, and then the difference in mortality between the two groups was compared.

Results

There was no significant difference in general information between the two groups (P>0.05). The total effective rate of the experimental group was significantly higher than that of the control group (χ²=6.318 and P<0.05). At T₂ and T₃, the HR and BR were significantly lower and the SpO₂ was significantly higher in the experimental group than the control group (P<0.05). At T₂ and T₃, the PCO₂ was significantly lower and the PH, PaO₂, LVEF and SV were significantly higher in the experimental group than the control group (P<0.05). At T₂ and T₃, the NT-proBNP and hs-CRP values in the experimental group were significantly lower than those of the control group (P<0.05). There was no significant difference in the number of patients with invasive mechanical respiration during the treatment between the two groups (χ²=2.074 and P=0.149). Log rank analysis showed that the risk of death in the experimental group was significantly lower than that of the control group (Log rank χ²=4.563 and P=0.034).

Conclusion

BiPAP can effectively improve the respiratory function and the cardiac function of the patients with type Ⅱ respiratory failure and heart failure. It can effectively treat the above diseases and improve the mortality within 1 year.

Key words: BiPAP, type Ⅱ heart failure, Heart failure, NT-proBNP, hs-CRP

表1 两组患者一般资料比较

临床资料		对照组(n＝31)	实验组(n＝30)	χ²/t值	P值
年龄(岁)
	<50	4	5	3.008	0.213
	50～60	17	21
	>60	10	4
BMI(kg·m^-2)		25.47±4.05	26.27±3.39	0.823	0.413
吸烟史		13(41.94)	16(53.33)	0.426	0.513
基础疾病
	高血压	24(77.42)	27(90.00)	0.659	0.416
	糖尿病	10(32.26)	9(30.00)	0.135	0.712
	冠心病	19(61.29)	21(70.00)	0.468	0.116
文化程度
	初中及以下	8(25.81)	6(20.00)	0.764	0.437
	高中/中专	15(48.38)	19(63.33)
	大专/本科以上	8(25.81)	5(16.67)

表1 两组患者一般资料比较

临床资料		对照组(n＝31)	实验组(n＝30)	χ²/t值	P值
年龄(岁)
	<50	4	5	3.008	0.213
	50～60	17	21
	>60	10	4
BMI(kg·m^-2)		25.47±4.05	26.27±3.39	0.823	0.413
吸烟史		13(41.94)	16(53.33)	0.426	0.513
基础疾病
	高血压	24(77.42)	27(90.00)	0.659	0.416
	糖尿病	10(32.26)	9(30.00)	0.135	0.712
	冠心病	19(61.29)	21(70.00)	0.468	0.116
文化程度
	初中及以下	8(25.81)	6(20.00)	0.764	0.437
	高中/中专	15(48.38)	19(63.33)
	大专/本科以上	8(25.81)	5(16.67)

表2 两组患者治疗前后三个时间点一般指标比较情况

组　别	例数	时间	HR(次/min)	BR(次/min)	SpO₂(%)	SBP(mmHg)	DBP(mmHg)
对照组	31	T₁	137.19±21.13	35.13±5.58	53.48±8.33	154.38±19.28	89.47±11.22
		T₂	123.14±17.92^a	30.14±4.47^a	59.29±9.14^a	144.39±14.27^a	87.14±14.28
		T₃	104.37±16.48^ab	20.48±3.72^ab	67.43±10.09^ab	139.48±11.25^ab	83.48±10.09
		F值	20.995	76.816	17.348	7.392	1.091
		P值	<0.001	<0.001	<0.001	0.001	0.156
实验组	30	T₁	141.43±24.08	34.28±5.95	51.38±8.92	152.49±21.39	91.34±14.97
		T₂	113.29±18.09^ac	26.49±4.72^ac	72.13±11.29^ac	141.32±14.29^a	86.13±13.28
		T₃	92.49±14.95^abc	17.05±3.47^abc	84.39±13.45^abc	137.14±12.33^ab	83.04±12.49
		F值	48.023	96.097	64.594	6.965	2.845
		P值	<0.001	<0.001	<0.001	0.002	0.063

表2 两组患者治疗前后三个时间点一般指标比较情况

组　别	例数	时间	HR(次/min)	BR(次/min)	SpO₂(%)	SBP(mmHg)	DBP(mmHg)
对照组	31	T₁	137.19±21.13	35.13±5.58	53.48±8.33	154.38±19.28	89.47±11.22
		T₂	123.14±17.92^a	30.14±4.47^a	59.29±9.14^a	144.39±14.27^a	87.14±14.28
		T₃	104.37±16.48^ab	20.48±3.72^ab	67.43±10.09^ab	139.48±11.25^ab	83.48±10.09
		F值	20.995	76.816	17.348	7.392	1.091
		P值	<0.001	<0.001	<0.001	0.001	0.156
实验组	30	T₁	141.43±24.08	34.28±5.95	51.38±8.92	152.49±21.39	91.34±14.97
		T₂	113.29±18.09^ac	26.49±4.72^ac	72.13±11.29^ac	141.32±14.29^a	86.13±13.28
		T₃	92.49±14.95^abc	17.05±3.47^abc	84.39±13.45^abc	137.14±12.33^ab	83.04±12.49
		F值	48.023	96.097	64.594	6.965	2.845
		P值	<0.001	<0.001	<0.001	0.002	0.063

表3 两组患者治疗前后三个时间点动脉血气分析及心功能指标比较

组　别	例数	时间	pH	PaO₂(mmHg)	PCO₂(mmHg)	LVEF(%)	SV(ml)
对照组	31	T₁	7.12±0.04	52.19±7.04	69.47±12.31	37.28±5.12	62.49±9.04
		T₂	7.24±0.03^a	58.32±6.98^a	66.28±10.02	40.32±6.13^a	66.37±8.27^a
		T₃	7.29±0.05^ab	62.13±7.09^ab	64.28±10.49	44.29±7.04^ab	72.23±10.05^ab
		F值	137.04	15.237	1.704	9.811	8.617
		P值	<0.001	<0.001	0.188	<0.001	<0.001
实验组	30	T₁	7.13±0.04	51.34±8.19	68.72±11.44	38.33±6.93	64.29±9.37
		T₂	7.29±0.03^ac	61.95±7.47^ac	62.18±9.02^ac	44.23±7.09^ac	71.29±10.18^ac
		T₃	7.35±0.04^abc	69.75±9.38^abc	56.72±8.13^abc	51.43±7.92^abc	79.42±12.01^abc
		F值	232.801	28.098	11.627	24.095	15.373
		P值	<0.001	<0.001	<0.001	<0.001	<0.001

表3 两组患者治疗前后三个时间点动脉血气分析及心功能指标比较

组　别	例数	时间	pH	PaO₂(mmHg)	PCO₂(mmHg)	LVEF(%)	SV(ml)
对照组	31	T₁	7.12±0.04	52.19±7.04	69.47±12.31	37.28±5.12	62.49±9.04
		T₂	7.24±0.03^a	58.32±6.98^a	66.28±10.02	40.32±6.13^a	66.37±8.27^a
		T₃	7.29±0.05^ab	62.13±7.09^ab	64.28±10.49	44.29±7.04^ab	72.23±10.05^ab
		F值	137.04	15.237	1.704	9.811	8.617
		P值	<0.001	<0.001	0.188	<0.001	<0.001
实验组	30	T₁	7.13±0.04	51.34±8.19	68.72±11.44	38.33±6.93	64.29±9.37
		T₂	7.29±0.03^ac	61.95±7.47^ac	62.18±9.02^ac	44.23±7.09^ac	71.29±10.18^ac
		T₃	7.35±0.04^abc	69.75±9.38^abc	56.72±8.13^abc	51.43±7.92^abc	79.42±12.01^abc
		F值	232.801	28.098	11.627	24.095	15.373
		P值	<0.001	<0.001	<0.001	<0.001	<0.001

表4 两组患者后三个时间点血浆NT-proBNP及hs-CRP值比较

组　别	指标	T₁	T₂	T₃	F值	P值
对照组	31	NT-proBN(pg·ml^-1)	3 682.41±349.23	2 421.43±201.49^a	1 126.41±98.04^ab	85.824	<0.001
		hs-CRP(mg·L^-1)	21.72±4.23	15.28±3.19^a	7.29±1.04^ab	16.337	<0.001
实验组	30	NT-proBN(pg·ml^-1)	3 716.42±314.94	1 920±189.39^ac	761.52±71.49^abc	98.284	<0.001
		hs-CRP(mg·L^-1)	22.49±4.92	12.37±3.02^ac	6.01±1.01^abc	24.941	<0.001

表4 两组患者后三个时间点血浆NT-proBNP及hs-CRP值比较

组　别	指标	T₁	T₂	T₃	F值	P值
对照组	31	NT-proBN(pg·ml^-1)	3 682.41±349.23	2 421.43±201.49^a	1 126.41±98.04^ab	85.824	<0.001
		hs-CRP(mg·L^-1)	21.72±4.23	15.28±3.19^a	7.29±1.04^ab	16.337	<0.001
实验组	30	NT-proBN(pg·ml^-1)	3 716.42±314.94	1 920±189.39^ac	761.52±71.49^abc	98.284	<0.001
		hs-CRP(mg·L^-1)	22.49±4.92	12.37±3.02^ac	6.01±1.01^abc	24.941	<0.001

图1 两组患者随访期间死亡风险分析ROC曲线

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Effect of bi-level noninvasive positive pressure ventilation on NT-proBNP and hs-CRP in patients with emergency type Ⅱ respiratory failure and heart failure

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Effect of bi-level noninvasive positive pressure ventilation on NT-proBNP and hs-CRP in patients with emergency type Ⅱ respiratory failure and heart failure