两种机械通气对 COPD肺动脉高压伴发呼吸衰竭老年患者的疗效及BNP水平的影响

摘要

Objective:To investigate the curative effect of mechanical ventilation on elder patients with pulmonary arterial hypertension associated with respiratory failure and influence on BNP level. Methods:56 cases of elder patients with pulmonary arterial hypertension associated with respiratory failure received treatment of mechanical ventilation. Patients were randomly divided into two groups:invasive mechanical ventilation group( assisted respiration of trachea cannula or tracheotomy breathing machine)and non-invasive mechanical ventilation group(assisted respiration of mask ventilator). The general information,pH value,the changes of pulmonary arterial pressure,the levels of BNP and blood gas analysis between two groups before and after 24h of treatment were compared. Results:There was no statistical difference concerning pH value,PaO2 ,PaCO2 ,pulmonary arterial pressure and BNP level between two groups(P>0. 05). Compared to the condition before the treatment,the related indexes of pH value and PaO2 in both groups were improved after 24 h of treatment,and PaCO2,pulmonary arterial pressure and BNP level were lower than before treatment(P<0. 05);the indexes of invasive mechanical ventilation group compared with that of non-invasive mechanical ventila-tion group were statistical significant( P<0 . 05 ). Conclusion:The effect in invasive mechanical ven-tilation group is better than that in non-invasive mechanical ventilation group,and the decrease of BNP level was obvious.%目的：探讨两种机械通气模式对慢性阻塞性肺疾病（ COPD）肺动脉高压伴发呼吸衰竭老年患者的疗效及脑钠肽（ BNP）水平的影响。方法：接受机械通气治疗的COPD肺动脉高压伴发呼吸衰竭的老年患者56例，随机均分成有创机械通气组（气管插管或气管切开行呼吸机实施辅助呼吸）和无创机械通气组（面罩呼吸机实施辅助呼吸）两组，比较治疗前和治疗24 h后两组患者 pH值、动脉血氧分压（ PaO2）、动脉血二氧化碳分压（ PaCO2）及肺动脉压力，同时测定血浆BNP水平。结果：治疗前，两组患者pH值、PaO2、PaCO2、肺动脉压及血浆BNP水平比较，差异无统计学意义（ P>0.05）；两组治疗24 h后pH值和PaO2高于治疗前，PaCO2、肺动脉压力及血浆BNP水平低于治疗前（ P<0.05）；治疗24 h后有创机械通气组6项指标与无创机械通气组比较，差异有统计学意义（ P<0.05）。结论：有创机械通气治疗COPD肺动脉高压伴发呼吸衰竭的老年患者效果优于无创机械通气，有创机械通气治疗患者BNP水平降低更为明显。