有创机械通气与无创机械通气治疗肺动脉高压并呼吸衰竭临床疗效的比较研究

摘要

Objective To compare the clinical effect in treating pulmonary hypertension patients complicated with respiratory failure between invasive mechanical ventilation and noninvasive mechanical ventilation. Methods From July 2012 to September 2014,a total of 108 pulmonary hypertension patients complicated with respiratory failure were selected in the ICU of Tumor Hospital Affiliated to Xinjiang Medical University,and they were divided into A group(n = 57)and B group(n = 51) according to mechanical ventilation methods. Based on conventional treatment,patients of A group received invasive mechanical ventilation,while patients of B group received noninvasive mechanical ventilation,both groups continuously treated for 2 weeks. Index of arterial blood - gas analysis(including pH,paO2 and paCO2 ),pulmonary artery pressure,serum levels of BNp,ET, AngⅡ and 6-keto-pGF1α,and renin activity before and after treatment were compared between the two groups,incidence of complications during treatment was observed. Results No statistically significant differences of pH,paO2 ,paCO2 or pulmonary artery pressure was found between the two groups before treatment(P > 0. 05);after treatment,pH and paO2 of A group were statistically significantly higher than those of B group,while paCO2 and pulmonary artery pressure of A group were statistically significantly lower than those of B group(P < 0. 05). No statistically significant differences of serum level of BNp,of ET,of AngⅡ,of 6-keto-pGF1α or pRA was found between the two groups before treatment(P > 0. 05);after treatment,serum levels of BNp,ET and AngⅡ,and renin activity of A group were statistically significantly lower than those of B group,while serum 6-keto-pGF1α level of A group was statistically significantly higher than that of B group ( P < 0. 05 ). The incidence of complications during treatment of B group was 43. 1% ,was statistically significantly lower than that of A group of 63. 2% (P <0. 05). Conclusion Invasive mechanical ventilation has better clinical effect in treating pulmonary hypertension patients complicated with respiratory failure than noninvasive mechanical ventilation,can effectively adjust the index of arterial blood - gas analysis,reduce the pulmonary artery pressure,but the incidence of complications is higher.%目的：比较有创机械通气与无创机械通气治疗肺动脉高压（pH）并呼吸衰竭的临床疗效。方法选取2012年7月—2014年9月新疆医科大学附属肿瘤医院 ICU 收治的 pH 并呼吸衰竭患者108例，根据通气方式不同分为有创机械通气57例（有创组）和面罩呼吸机辅助呼吸51例（无创组）。在常规治疗基础上有创组患者采用有创机械通气治疗，无创组患者采用面罩呼吸机辅助呼吸治疗，两组患者均治疗2周。比较两组患者治疗前后动脉血气分析指标〔包括 pH 值、动脉血氧分压（paO2）、动脉血二氧化碳分压（paCO2）〕、肺动脉压及血清脑钠肽（BNp）、内皮素（ET）、血管紧张素Ⅱ（AngⅡ）、6-酮-前列腺素 F1α（6-keto-pGF1α）水平和肾素活性（pRA），观察两组患者治疗期间并发症发生情况。结果治疗前两组患者 pH 值、paO2、paCO2及肺动脉压比较，差异无统计学意义（ P >0.05）；治疗后有创组患者 pH 值、paO2高于无创组，paCO2、肺动脉压低于无创组（ P <0.05）。治疗前两组患者血清 BNp、ET、AngⅡ、6-keto-pGF1α水平及 pRA 比较，差异无统计学意义（P >0.05）；治疗后有创组患者血清 BNp、ET、AngⅡ水平及 pRA 低于无创组，血清6-keto-pGF1α水平高于无创组（P <0.05）。治疗期间无创组患者并发症发生率为43.1%，低于有创组的63.2%（P <0.05）。结论有创机械通气治疗 pH 并呼吸衰竭的临床疗效优于无创机械通气，能有效改善患者血气指标、降低肺动脉压，但其并发症发生率较高。