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

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

Abstract

Abstract:

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

Yane Zheng, Hui Luo, Hang Yang, Dayong Sun. 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[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2020, 13(02): 236-241.

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References 30

1	Mosier JM, Hypes C, Joshi R, et al. Ventilator strategies and rescue therapies for management of acute respiratory failure in the emergency department.[J]. Ann Emerg Med, 2015, 66(5): 529-541.
2	João Pedro Ferreira, Rossignol P, Demissei B, et al. Coronary angiography in worsening heart failure: determinants, findings and prognostic implications[J]. Heart, 2018, 104(7): 606-613.
3	Pyatt JR, Jackson M. The acute haemodynamic effects of nasal ventilation by CPAP and BiPAP in patients with congestive heart failure[J]. Eur J Heart Fail, 2015, 2(S1): 97-97.
4	Mcgee WT. Noninvasive ventilation using bipap: expanding indications to post cardiac surgery care[J]. Ann Card Anaesth, 2018, 21(1): 6-7.
5	Don-Wauchope A, Mckelvie R. Evidence based application of BNP/NT-proBNP testing in heart failure[J]. Clin Biochem, 2015, 48(4-5): 236-246.
6	洪　飞，汪　磊. 慢性心力衰竭患者血清CA125、hs-CRP和TNF-α水平及其与心功能的关系[J]. 中国医科大学学报，2017, 46(9): 787-790.
7	葛均波，徐永建. 内科学[M]. 第8版，北京：人民卫生出版社，2013: 137-147.
8	中华医学会心血管病学分会，中华心血管病杂志编辑委员会. 中国心力衰竭诊断和治疗指南2014[J]. 中华心血管病杂志，2014, 42(2): 98-122.
9	Ferrer M, Bernadich O, Nava S, et al. Noninvasive ventilation after intubation and mechanical ventilation[J]. Eur Respir J, 2002, 19(5): 959-965.
10	Piroddi I, Karamichali S, Nicolini A, et al. Efficacy of non-invasive ventilation for hypercapnic acute respiratory failure in a general ward: details and comments[J]. Intern Med J, 2015, 45(11): 1201-1202.
11	Wolfram W, Jens G, Karsten S, et al. German National Guideline for treating chronic respiratory failure with invasive and non-invasive ventilation-revised edition 2017: Part 2[J]. Respiration, 2018, 96(1): 66-97.
12	Minami Y, Kajimoto K, Sato N, et al. C-reactive protein level on admission and time to and cause of death in patients hospitalized for acute heart failure[J]. Eur Heart J Qual Care Clin Outcomes, 2017, 3(2): 148-156.
13	Delorme M, Bouchard PA, Simon M, et al. Effects of High-Flow nasal cannula on the work of breathing in patients recovering from acute respiratory failure[J]. Crit Care Med, 2017, 45(12): 1981-1988.
14	Kuklisova Z, Tkacova R, Joppa P, et al. Severity of nocturnal hypoxia and daytime hypercapnia predict CPAP failure in patients with COPD and obstructive sleep apnea overlap syndrome[J]. Sleep Med, 2017, 30: 139-145.
15	Juan Carlos García-Rubira, Cristo-Ropero MJ, Almendro-Delia M, et al. A new sign of severe aortic regurgitation detected through airflow analysis in mechanical ventilation[J]. J Heart Valve Dis, 2017, 26(1): 121.
16	De Backer L, Vos W, Dieriks B, et al. The effects of long-term noninvasive ventilation in hypercapnic COPD patients: a randomized controlled pilot study[J]. Int J Chron Obstruct Pulmon Dis, 2011, 6: 615-624.
17	杜纪兵，李文宇，霍星宇，等. 无创呼吸机在急性射血分数保留心衰中的应用[J]. 中华急诊医学杂志，2019, 28(7): 831-835.
18	刘又宁. 呼吸内科学[M]. 北京：人民军医出版社，2010: 239-245.
19	Combret Y, Prieur G, Roux PL, et al. Non-invasive ventilation improves respiratory distress in children with acute viral bronchiolitis: A systematic review[J]. Minerva Anestesiol, 2017, 83(6): 624-637.
20	Cíntia Lourenco Santos, Moraes L, Santos RS, et al. The biological effects of higher and lower positive end-expiratory pressure in pulmonary and extrapulmonary acute lung injury with intra-abdominal hypertension[J]. Crit Care, 2014, 18(3): R121.
21	Hori R, Ishida R, Isaka M, et al. Effects of noninvasive ventilation on the coordination between breathing and swallowing in patients with chronic obstructive pulmonary disease[J]. Int J Chron Obstruct Pulmon Dis, 2019, 14: 1485-1494.
22	Akizuki M, Serizawa N, Ueno A, et al. Effect of balloon pulmonary angioplasty on respiratory function in patients with chronic thromboembolic pulmonary hypertension[J]. Chest, 2017, 151(3): 643-649.
23	Sikachi RR, Sahni S, Mehta D, et al. Nationwide trends in inpatient admissions of pulmonary hypertension in the United States from 2000 to 2013[J]. Adv Respir Med, 2017, 85(2): 77-86.
24	刘　艳，马　龙. 双水平无创正压通气在抢救急性重度左心衰伴Ⅱ型呼吸衰竭中的应用效果[J]. 热带医学杂志，2017, (1): 91-94.
25	Luchner A, Von HS, Holubarsch C, et al. Indications and clinical implications of the use of the cardiac markers BNP and NT-proBNP[J]. Dtsch Med Wochenschr, 2017, 142(5): 346-355.
26	Labaki WW, Meng X, Susan M, et al. NT-proBNP in stable COPD and future exacerbation risk: Analysis of the SPIROMICS cohort[J]. Respir Med, 2018, 140: 87-93.
27	Kamath DY, Xavier D, Sigamani A, et al. High sensitivity C-reactive protein (hsCRP) & cardiovascular disease: An Indian perspective[J]. Indian J Med Res, 2015, 142(3): 261-268.
28	Araz O, Yilmazel Ucar E, Yalcin A, et al. Predictive value of serum Hs-CRP levels for outcomes of pulmonary embolism[J]. Clin Respir J, 2016, 10(2): 163-167.
29	中国医师协会急诊医师分会，中国医疗保健国际交流促进会急诊急救分会，国家卫生健康委能力建设与继续教育中心急诊学专家委员会. 无创正压通气急诊临床实践专家共识(2018)[J]. 中华急诊医学杂志，2019, 28(1): 14-24.
30	Liu YJ, Zhao J, Tang H. Non-invasive ventilation in acute respiratory failure: a meta-analysis[J]. Clin Med (Lond), 2016, 16(6): 514-523.

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)

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)

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

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

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

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