目的:观察无创正压通气( nasal inlermittent positive pressure ventilation,NIPPV)对慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease,AECOPD)合并Ⅱ型呼吸衰竭患者血浆N端脑利钠肽(N-terminal pro-brain natriuretic peptidc,NT-proBNP)水平的影响并探讨其.意义.方法:随机选择AECOPD合并Ⅱ型呼吸衰竭患者及慢性阻塞性肺疾病稳定期患者各40例,检测血浆NT-proBNP水平并分析其与动脉血气、APACIIE Ⅱ评分及肺动脉压力之间的相关性;比较两组血浆NT-proBNP水平;比较NIPPV治疗前后AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平.结果:血浆NT-proBNP与pH值、PaO2呈负相关(分别为r=-0.691和r=-0.704,均P＜0.001),与PaCO2或APACHEⅡ评分呈正相关(分别为r=0.774和r=0.810,均P＜0.001),与肺动脉压力呈正相关(r=0.965,P＜0.001); AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP与pH值、PaO2呈负相关(分别为r=-0.636和r=-0.616,均P＜0.001),与 PaCO2,APACHEⅡ评分呈正相关(分别为r-0.545和r=0.475, P=0.001.P=0.002),与肺动脉压力呈正相关(r-0.833,P＜0.001); AECOPD合并Ⅱ型呼吸衰竭组血浆NT-proBNP明显高于慢性阻塞性肺疾病稳定期组[(939.60±250.00 ) pg/mLvs(151.55 ± 111.20) pg/mL,P＜0.01];NIPPV治疗24 h后血气指标好转、APACHEⅡ评分下降,血浆NT-proBNP较治疗前下降[(229.15±98.26) pg/mL vs (939.60±250.00) pg/mL,p＜0.01];治疗后肺动脉压力较治疗前下降,但差异无统计学意义(P=0.056).结论:血浆NT-proBNP浓度反映了AECOPD合并Ⅱ型呼吸衰竭患者病情的严重程度;NIPPV能降低该类患者的血浆NT-proBNP浓度,NT-proBNP浓度变化有助于评价NIPPV疗效.%Objective: To investigate the effect of nasal intermittent positive pressure ventilation (NIPPV) on N-terminal pro-brain natriuretic peptide (NT-proBNP) in patients with acute exacerbations of chronic obstructive pulmonary disease (AECOPD) and type II respiratory failure. Methods: Forty patients with AECOPD and type II respiratory failure and 40 patients with stable phase chronic obstructive pulmonary disease were randomly assigned into study. Plasma levels of NT-proBNP, arterial blood gas, APACHE II scores, and pulmonary artery pressures were measured. The plasma level of NT-proBNP was compared between the two groups. Effect of NIPPV on NT-proBNP was studied in patients with AECOPD and type II respiratory failure. Results: There were negative correlations between NT-proBNP and pH, and between NT-proBNP and PaO2(r=-0.691,r=-0.704,respectively;P<0.001),positive correlations between NT-proBNP and PaCO2, and between NT-proBNP and APACHE II scores (r=0.774, r=0.810, respectively, P< 0.001), and positive correlation between NT-proBNP and PAP (r=0.965, P<0.001) in all patients. In patients with AECOPD and type II respiratory failure, there were negative correlations between NT-proBNP and pH,and between NT-proBNP and PaO2 (r=~0.636, r=-0.616,respectively; P<0.001); there were positive correlations between NT-proBNP and PaCO2, and between NT-proBNP and APACHE II scores (r=0.545, r=0.47S, respectively; P=0.001, P=0.002); and there were positive correlation between NT-proBNP and pulmonary artery pressure (r=0.833,P<0.001). The plasma levels of NT-proBNP were significantly higher in patients with AECOPD and type II respiratory failure than in control subjects [(939.60 ± 250.00) pg/mL vs (151.55 ± 111.20) pg/mL;P<0.01]. NIPPV decreased plasma levels of NT-proBNP [(229.15 + 98.26) pg/mL vs (939.60 + 250.00) pg/mL; P<0.01] in patients with AECOPD and type II respiratory failure, as well as improved arterial blood gas and APACHE II scores. Although NIPPV appeared to decrease pulmonary artery pressure somewhat between pre-treatment and post-treatment groups, the differences were not statistically significant (P=0.056).rnConclusion: The plasma level of NT-proBNP reflects the severity of patients with AECOPD and type II respiratory failure. NIPPV can decrease a patient s splasma level of NT-proBNP, which has clinical value for evaluating the effect of NIPPV
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