BiPAP无创呼吸机救治肺心病急性加重期疗效及对血清NT-proBNP、动脉血气指标和肺功能的影响

doi:10.3877/cma.j.issn.1674-6902.2023.01.002

目的

分析双水平气道正压(BiPAP)无创呼吸机治疗慢性肺源性心脏病(chronic pulmonary heart disease, CPHD)急性加重期的疗效，分析其对血清氨基末端B型脑钠肽前体(NT-proBNP)、动脉血气指标和肺功能的影响。

方法

选取2019年1月至2021年12月我院收治的154例CPHD急性加重期患者为对象，随机分为对照组74例与观察组80例。对照组给予抗感染、氧疗、利尿、强心等常规治疗；观察组则联合BiPAP呼吸机辅助治疗，7 d为1个疗程。记录两组临床疗效，比较治疗前、治疗3 d后、治疗7 d后血清学指标[NT-proBNP、可溶性生长刺激表达因子2(sST2)]、动脉血气指标[动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)、酸碱度(pH)]及治疗前、治疗7 d后心功能指标[左心室射血分数(LVEF)、心脏指数(CI)]、肺功能指标[第一秒用力呼气量(FEV₁)、用力肺活量(FVC)、呼气峰流速占预计值比(PEF%)]。

结果

观察组总有效率高于对照组(95.00% vs. 87.84%，P<0.05)。两组治疗前后血清NT-proBNP、sST2及PaO₂、PaCO₂、pH存在显著交互效应(P<0.05)；治疗7 d后，观察组血清NT-proBNP、sST2、PaCO₂降低至(1 983.41±204.35)pg/ml、(244.69±48.62)ng/L、(47.96±4.12)mmHg，对照组降低至(2 447.39±241.28)pg/ml、(281.85±50.33)ng/L、(50.05±3.81)mmHg，两组较治疗前降低，观察组明显低(P<0.05)；观察组PaO₂、pH升高至(69.88±4.22)mmHg、(7.40±0.03)，对照组升高至(66.21±5.71)mmHg、(7.37±0.04)mmHg，观察组治疗后高于对照组(P<0.05)；观察组LVEF、CI及FEV₁、FVC、PEF%升高至(58.29±5.22)%、(2.78±0.49)ml/(min·m²)、(0.97±0.16)L、(1.89±0.31)L、(58.44±4.97)%，对照组升高至(54.14±4.76)%、(2.46±0.42)ml/(min·m²)、(0.88±0.15)L、(1.71±0.27)L、(53.06±5.12)%，观察组治疗后高于对照组(P<0.05)。

结论

BiPAP无创呼吸机用于CPHD急性加重期治疗，提升患者心肺功能，疗效显著，具有临床意义。

关键词: 急性加重，心脏病，慢性肺源性, 双水平气道正压, 心功能, 肺功能

Objective

To evaluate the efficacy of bilevel positive airway pressure (BiPAP) non-invasive ventilator in the treatment of acute exacerbation of chronic pulmonary heart disease (CPHD), and to analyze its effects on serum N-terminal pro-brain natriuretic peptide (NT-proBNP), arterial blood gas indicators and pulmonary function.

Methods

154 patients with acute exacerbation of CPHD who were treated in West China Hospital, Sichuan University from January 2019 to December 2021 were selected as the research subjects, and they were divided into control group 74 cases and observation group 80 cases by the remainder grouping method of the random number table method. The control group was given conventional treatments such as anti-infection, oxygen therapy, diuretic therapy and cardiotonic therapy, while the observation group was given BiPAP ventilator adjuvant therapy on the basis of the non-BiPAP group, with 7 days as a course of treatment. The clinical efficacy of the two groups of patients was recorded, and the serological indicators NT-proBNP, sST2 and arterial blood gas indicators PaO₂, PaCO₂, pH before treatment, after 3 days of treatment and after 7 days of treatment as well as cardiac function indicators LVEF, CI and pulmonary function indicators FEV₁, FVC, PEF% before treatment and after 7 days of treatment were compared.

Results

The total effective rate in observation group was significantly higher than that in control group (95.0% vs. 87.84%, P<0.05). There were significant interaction effects in serum NT-proBNP, sST2 and PaO₂, PaCO₂ and pH in both groups of patients before and after treatment (all P<0.05). After treatment, the levels of serum NT-proBNP, sST2 and PaCO₂ in observation group were decreased to (1, 983.41±204.35) pg/ml, (244.69±48.62) ng/L and (47.96±4.12) mmHg after 7 days of treatment, and the levels in control group were reduced to (2, 447.39±241.28) pg/ml, (281.85±50.33) ng/L and (50.05±3.81) mmHg, and the levels in observation group were lower compared with those in control group after treatment (P<0.05). The PaO₂ and pH in observation group were increased to (69.88±4.22) mmHg and (7.40±0.03) after 7 days of treatment, and the two indicators in control group were increased to (66.21±5.71) mmHg and (7.37±0.04), and the indicators in observation group after treatment were higher than those in control group (P<0.05). The LVEF, CI, FEV₁, FVC and PEF% in observation group were increased to (58.29±5.22)%, (2.78±0.49) ml/(min·m²), (0.97±0.16) L, (1.89±0.31) L and (58.44±4.97)% after 7 days of treatment, and the indicators in control group were enhanced to (54.14±4.76)%, (2.46±0.42) ml/(min·m²), (0.88±0.15) L, (1.71±0.27)L and (53.06±5.12)% after 7 days of treatment, and the indicators were higher in observation group than those in control group after treatment (P<0.05).

Conclusion

BiPAP non-invasive ventilator for the treatment of acute exacerbation of CPHD can significantly improve the cardiopulmonary function, and it has a significant efficacy and has certain clinical value.

Key words: Chronic pulmonary heart disease, Acute exacerbation, Bilevel positive airway pressure, Cardiac function, Pulmonary function

表1 两组CPHD患者血清NT-proBNP、sST2比较(±s)

组　别	例数	NT-proBNP(pg/ml)			sST2(ng/L)
组　别	例数	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d
观察组	80	5 976.24±1 049.57	3 962.55±694.08^a	1 983.41±204.35^ab	587.44±98.36	395.28±65.19^a	244.69±48.62^ab
对照组	74	5 898.83±997.46	4 489.18±712.30^a	2 447.39±241.28^ab	579.83±101.27	436.11±71.03^a	281.85±50.33^ab
t值		0.469	4.647	12.877	0.473	3.716	4.660
P值		0.640	0.000	0.000	0.637	0.000	0.000

表1 两组CPHD患者血清NT-proBNP、sST2比较(±s)

组　别	例数	NT-proBNP(pg/ml)			sST2(ng/L)
组　别	例数	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d
观察组	80	5 976.24±1 049.57	3 962.55±694.08^a	1 983.41±204.35^ab	587.44±98.36	395.28±65.19^a	244.69±48.62^ab
对照组	74	5 898.83±997.46	4 489.18±712.30^a	2 447.39±241.28^ab	579.83±101.27	436.11±71.03^a	281.85±50.33^ab
t值		0.469	4.647	12.877	0.473	3.716	4.660
P值		0.640	0.000	0.000	0.637	0.000	0.000

表2 两组CPHD患者PaO₂、PaCO₂、pH比较(±s)

组　别	例数	PaO₂(mmHg)			PaCO₂(mmHg)			pH
组　别	例数	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d
观察组	80	54.49±4.08	64.92±5.17^a	69.88±4.22^ab	67.22±3.98	52.48±4.75^a	47.96±4.12^ab	7.29±0.04	7.36±0.05^a	7.40±0.03^ab
对照组	74	55.12±3.62	62.07±4.63^a	66.21±5.71^ab	66.44±3.53	58.33±4.09^a	50.05±3.81^ab	7.30±0.03	7.34±0.04^a	7.37±0.04^ab
t值		1.014	3.603	4.536	1.287	8.189	3.268	1.755	2.741	5.265
P值		0.312	0.001	0.000	0.200	0.000	0.002	0.081	0.007	0.000

表2 两组CPHD患者PaO₂、PaCO₂、pH比较(±s)

组　别	例数	PaO₂(mmHg)			PaCO₂(mmHg)			pH
组　别	例数	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d	治疗前	治疗3 d	治疗7 d
观察组	80	54.49±4.08	64.92±5.17^a	69.88±4.22^ab	67.22±3.98	52.48±4.75^a	47.96±4.12^ab	7.29±0.04	7.36±0.05^a	7.40±0.03^ab
对照组	74	55.12±3.62	62.07±4.63^a	66.21±5.71^ab	66.44±3.53	58.33±4.09^a	50.05±3.81^ab	7.30±0.03	7.34±0.04^a	7.37±0.04^ab
t值		1.014	3.603	4.536	1.287	8.189	3.268	1.755	2.741	5.265
P值		0.312	0.001	0.000	0.200	0.000	0.002	0.081	0.007	0.000

表3 两组CPHD患者LVEF、CI比较(±s)

组　别	例数	LVEF(%)		CI[ml/(min·m²)]
组　别	例数	治疗前	治疗7 d	治疗前	治疗7 d
观察组	80	42.91±4.33	58.29±5.22^a	1.51±0.29	2.78±0.49^a
对照组	74	43.15±4.02	54.14±4.76^a	1.54±0.31	2.46±0.42^a
t值		0.356	5.155	0.620	4.351
P值		0.722	0.000	0.536	0.000

表3 两组CPHD患者LVEF、CI比较(±s)

组　别	例数	LVEF(%)		CI[ml/(min·m²)]
组　别	例数	治疗前	治疗7 d	治疗前	治疗7 d
观察组	80	42.91±4.33	58.29±5.22^a	1.51±0.29	2.78±0.49^a
对照组	74	43.15±4.02	54.14±4.76^a	1.54±0.31	2.46±0.42^a
t值		0.356	5.155	0.620	4.351
P值		0.722	0.000	0.536	0.000

表4 两组CPHD患者FEV₁、FVC、PEF%比较(±s)

组　别	例数	FEV₁(L)		FVC(L)		PEF%(%)
组　别	例数	治疗前	治疗7 d	治疗前	治疗7 d	治疗前	治疗7 d
观察组	80	0.79±0.13	0.97±0.16^a	1.42±0.25	1.89±0.31^a	45.98±5.29	58.44±4.97^a
对照组	74	0.80±0.12	0.88±0.15^a	1.44±0.23	1.71±0.27^a	46.78±4.93	53.06±5.12^a
t值		0.496	3.601	0.517	3.842	0.971	6.616
P值		0.621	0.001	0.606	0.000	0.333	0.000

表4 两组CPHD患者FEV₁、FVC、PEF%比较(±s)

组　别	例数	FEV₁(L)		FVC(L)		PEF%(%)
组　别	例数	治疗前	治疗7 d	治疗前	治疗7 d	治疗前	治疗7 d
观察组	80	0.79±0.13	0.97±0.16^a	1.42±0.25	1.89±0.31^a	45.98±5.29	58.44±4.97^a
对照组	74	0.80±0.12	0.88±0.15^a	1.44±0.23	1.71±0.27^a	46.78±4.93	53.06±5.12^a
t值		0.496	3.601	0.517	3.842	0.971	6.616
P值		0.621	0.001	0.606	0.000	0.333	0.000

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Efficacy of BiPAP non-invasive ventilator in the treatment and cure of acute exacerbation of pulmonary heart disease and its effects on serum NT-proBNP, arterial blood gas indicators and pulmonary function

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Efficacy of BiPAP non-invasive ventilator in the treatment and cure of acute exacerbation of pulmonary heart disease and its effects on serum NT-proBNP, arterial blood gas indicators and pulmonary function