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

1	高　瞻，王　维，陈华萍，等. COPD合并肺心病患者的心电图与超声心动图特征比较分析[J/CD]. 中华肺部疾病杂志(电子版), 2019, 12(6): 687-690.
2	中华医学会，中华医学会临床药学分会，中华医学会杂志社，等．慢性肺源性心脏病基层合理用药指南[J]. 中华全科医师杂志，2020, 19(9): 792-798.
3	钏丽波，王　丹，陈国兵，等. BiPAP呼吸机联合坎地沙坦酯对肺心病急性期合并呼吸衰竭老年患者心肺功能及血清内皮素-1、Clara细胞蛋白和Copeptin水平的影响[J]. 中国老年学杂志，2020, 40(1): 1-4.
4	中华医学会，中华医学会杂志社，中华医学会全科医学分会，等. 慢性肺源性心脏病基层诊疗指南(实践版·2018)[J]. 中华全科医师杂志，2018, 17(12): 966-969.
5	张建玲，黄学玲. 还原型谷胱甘肽对慢性肺源性心脏病急性加重期患者血流动力学及氧化和抗氧化指标的影响[J]. 解放军医药杂志，2022, 34(6): 104-113.
6	刘　璐，李　林，赖　倩. 双水平气道正压通气联合肺康复治疗慢性阻塞性肺病合并慢性呼吸衰竭患者的疗效观察[J]. 实用医院临床杂志，2020, 17(4): 194-197.
7	Zinchuk AV, Chu JH, Liang J, et al. Physiological traits and adherence to sleep apnea therapy in individuals with coronary artery disease[J]. Am J Respir Crit Care Med, 2021, 204(6): 703-712.
8	汤建华，项保利，张长洪，等. 波生坦片联合无创通气治疗慢性肺心病患者的临床研究[J]. 中国临床药理学杂志，2020, 36(11): 1423-1426.
9	Zota IM, Sttescu C, Sascu RA, et al. Arterial stiffness assessment using the arteriograph in patients with moderate-severe osa and metabolic syndrome-a pilot study[J]. J Clin Med, 2021, 10(18): 4238-4246.
10	Yamanoglu A, Bilgin S, Celebi Yamanoglu NG, et al. A rare complication of continuous positive airway pressure treatment-rectus sheath hematoma: a case report[J]. Braz J Anesthesiol, 2021, 71(4): 461-463.
11	Zou J, Gu L. Effects of comprehensive care on complications, oxygenation indexes and guardian′s psychological mood of children with neonatal respiratory distress syndrome[J]. Am J Transl Res, 2021, 13(5): 5147-5155.
12	Sarker HN, Alam MM, Vadury SC, et al. Use of BODE index to assess prognosis of patients with COPD[J]. Mymensingh Med J, 2022, 31(2): 443-448.
13	高　雅，李　想，周晓静. BiPAP无创呼吸机治疗COPD急性加重期患者的疗效及安全性[J]. 河北医学，2020, 26(12): 2021-2024.
14	Zochios V, Chandan JS, Schultz MJ, et al. The effects of escalation of respiratory support and prolonged invasive ventilation on outcomes of cardiac surgical patients: a retrospective cohort study[J]. J Cardiothorac Vasc Anesth, 2020, 34(5): 1226-1234.
15	Yukino M, Nagatomo Y, Goda A, et al. Association of non-invasive positive pressure ventilation with short-term clinical outcomes in patients hospitalized for acute decompensated heart failure[J]. J Clin Med, 2021, 10(21): 5092-5099.
16	Yoon SY, Kim HK, Kim MJ, et al. Factors associated with assisted ventilation use in amyotrophic lateral sclerosis: a nationwide population-based study in Korea[J]. Sci Rep, 2021, 11(1): 1-10.
17	Youssef A, Kouchaki S, Shamout F, et al. Development and validation of early warning score systems for COVID-19 patients[J]. Healthc Technol Lett, 2021, 8(5): 105-117.
18	Yuan G, Liu H, Wu Z, et al. Evaluation of three non-invasive ventilation modes after extubation in the treatment of preterm infants with severe respiratory distress syndrome[J]. J Perinatol, 2022, 42(9): 1238-1243.
19	孙　瑜，施云超，赵正宇. 不同剂量右美托咪定在急性加重期慢性阻塞性肺疾病并肺性脑病患者中的应用比较[J]. 广东医学，2020, 41(4): 421-424.
20	Zhu Z, Wang M, Lin W, et al. Cardiac biomarkers, cardiac injury, and comorbidities associated with severe illness and mortality in coronavirus disease 2019 (COVID-19): A systematic review and meta-analysis[J]. Immun Inflamm Dis, 2021, 9(4): 1071-1100.
21	靳雅玲，杨瑞敏，张　冉，等. iNO联合HFOV在新生儿肺动脉高压中的应用及其对NGAL、NT-proBNP和ARNT的影响[J]. 临床肺科杂志，2022, 27(5): 681-686.
22	Huang N, Cui X, Li W, et al. IL33/ST2 promotes the malignant progression of gastric cancer via the MAPK pathway[J]. Mol Med Rep, 2021, 23(5): 361-368.
23	刘鹏飞，徐　彬，张　羽，等. 慢性肺源性心脏病急性加重期早期检测sST2和PAB的临床意义[J]. 中国急救复苏与灾害医学杂志，2020, 15(8): 915-918.
24	Dikme R, Padak M, Işık M, et al. Soluble ST2 as a potential biomarker in pericardial fluid of coronary artery patients[J]. Braz J Cardiovasc Surg, 2021, 36(5): 677-684.
25	王子丹，李　荣，李俊芳，等. 不同机械通气水平对急性呼吸窘迫综合征右心功能影响的动物实验研究[J]. 中华急诊医学杂志，2020, 29(3): 365-372.
26	Yong SY, Siop S, Kho WM. A cross-sectional study of early mobility practice in intensive care units in Sarawak Hospitals, Malaysia[J]. Nurs Open, 2020, 8(1): 200-209.
27	Xu Z, Sheng D, Jiao K, et al. Factors affecting abnormal triggering with non-invasive ventilators: A before-and-after study[J]. Clin Respir J, 2022, 16(6): 450-459.
28	汤建华，项保利，张长洪，等. 波生坦片联合无创通气治疗慢性肺心病患者的临床研究[J]. 中国临床药理学杂志，2020, 36(11): 1423-1426.
29	江文龙，李　雯，程芳洲，等. 无创通气对肺源性心脏病合并OSAHS病人心律失常的影响[J]. 中西医结合心脑血管病杂志，2020, 18(8): 1263-1266.

[1]	杨茂宪, 沈鹏, 王倩倩, 吴旺, 沈永帅, 蒋禛, 徐龙生, 朱建刚, 刘倍倍. 吡啶甲酸镁联合地塞米松对急性呼吸窘迫综合征大鼠的治疗作用研究[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(03): 196-203.
[2]	吴越廷, 周林雨涵, 胡钦, 许华燕, 黄敏, 陈晓勇, 张萌, 李中会, 茹凉, 王秋, 蔡晓唐. 皮质类固醇治疗非卧床杜氏肌营养不良症患儿肺功能与运动功能的纵向研究[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(03): 292-301.
[3]	沈琪乐, 赵勤华, 宫素岗, 刘锦铭, 王岚, 邱宏玲. COPD 稳定期患者血清CC16 蛋白表达与肺功能、肺气肿表型的关系分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 690-695.
[4]	杨莎莎, 张毛为, 孙宜田, 刘亚南, 位娟, 魏建, 陈碧. 结缔组织疾病相关间质性肺病并发小气道功能障碍临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 738-743.
[5]	郭璟琪, 魏明言, 刘芳, 李冬凌, 关金平, 李立华. 乙酰半胱氨酸治疗慢性阻塞性肺疾病急性加重期的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 768-772.
[6]	刘雯, 赵明栋, 夏伟, 潘以雄. 不同剂量比阿培南治疗重症肺炎的疗效分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(05): 789-792.
[7]	张璇, 高杨, 房雅君, 姚艳玲. 保护性机械通气在肺癌胸腔镜肺段切除术中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 563-567.
[8]	陈冬丽, 邓迎丽, 毕婧. α-干扰素治疗急性呼吸道病毒感染对Th1/Th2平衡及肺功能的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 590-594.
[9]	王微, 丁霖, 陈茜, 呼延欣, 闫蓓. 综合治疗对慢性阻塞性肺疾病的疗效及转归影响分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(04): 621-624.
[10]	周璇, 谢莉, 邹娟. 尼达尼布对特发性肺纤维化肺功能、肺纤维化程度及PDGF、PGE2、TGF-β1的影响[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 368-372.
[11]	袁广琴, 朱珠, 林云霞. 胸腺肽联合无创正压通气救治AECOPD并发Ⅱ型呼吸衰竭患者的临床分析[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 438-441.
[12]	罗孝平, 封敏, 黄川, 唐茜, 蒋艳, 胡莉丽. 渐进式抗阻训练干预在非小细胞肺癌中的临床应用[J/OL]. 中华肺部疾病杂志(电子版), 2024, 17(03): 472-474.
[13]	陈先志, 许磊, 冯其柱, 王琦. 布地奈德联合复方异丙托溴铵雾化吸入在老年患者腹腔镜围手术期中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(04): 531-536.
[14]	闫维, 张二明, 张克, 安欣华, 向平超. 北京市石景山区40岁及以上居民早期慢性阻塞性肺疾病异质性及影响因素分析[J/OL]. 中华临床医师杂志(电子版), 2024, 18(06): 533-540.
[15]	钱锦华, 曹超, 徐敏, 左迪迪, 曹洁, 张婷, 翁玉蓉, 胡耀敏. 骨骼肌减少症与老年患者心脏结构及功能的相关性研究[J/OL]. 中华老年病研究电子杂志, 2024, 11(03): 14-18.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

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

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

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