无创机械通气治疗对慢性阻塞性肺疾病急性加重期患者血浆脑钠肽表达的影响

摘要

目的 评估慢性阻塞性肺疾病急性加重期患者住院治疗使用无创机械通气治疗后患者血清超敏C反应蛋白(CRP)及血浆脑钠肽(brain natriuretic peptide,BNP)表达的影响.方法 连续选取2015年7月至2016年10月大连医科大学附属第一医院呼吸内科住院治疗的急性加重期慢阻肺患者24例,给予无创通气治疗.通过CAT评分对患者慢阻肺症状进行评估;留取无创通气治疗前及治疗1周后受试者空腹静脉血清,血浆分别用于检测hsCRP、BNP水平,同时测定动脉血气分析.结果 本研究共纳入24例急性加重期慢阻肺患者,其中入院前6个月内稳定期肺功能分级III级8例,IV级16例;男18例,女6例.无创机械通气治疗后患者动脉血氧分压、二氧化碳分压及患者CAT评分均较治疗前有所改善,差异有统计学意义(P<0.05);治疗前后患者血清hsCRP及血浆BNP水平的较前改善,差异有统计学意义(P<0.05).结论 慢性阻塞性肺疾病急性加重期患者经无创正压通气治疗后患者临床症状和相应指标改善,且hsCRP及BNP水平随之下降;其可能归因于无创通气治疗改善慢阻肺患者改善炎症反应水平和心脏负荷,从而改善患者预后.%Objective To assess the effects of noninvasive mechanical ventilation on the expression of serum high-sensi-tivity C reactive protein(hsCRP)and brain natriuretic peptide(BNP)in the treatment of hospitalized patients with acute exacerba-tion of chronic obstructive pulmonary disease(AECOPD). Methods 24 patients with AECOPD received in the department of re-spiratory medicine,the First Affiliated Hospital of Dalian Medical University during July 2015 to October 2016 were included and treated with noninvasive ventilation. Symptoms of COPD were evaluated by CAT score. Fasting venous serum and plasma samples both before noninvasive ventilation treatment and 1-week after treatment were preserved for determination of hsCRP and BNP,and simultaneously,arterial blood gas analysis was processed. Results 24 cases of AECOPD were included in this study,among which there were 8 cases of grade Ⅲ pulmonary function and 16 cases of grade Ⅳ pulmonary function during stable phase of COPD,6 months before admission. There were 18 male patients and 6 female patients. After noninvasive mechanical ventilation,arterial partial pressure of oxygen as well as carbon dioxide and CAT scores of patients were improved when compared with pretreated con-dition,the difference being statistically significant(P <0.05). The post-treatment serum hsCRP and BNP level of patients im-proved when compared with pretreated level,the difference being statistically significant(P<0.05). Conclusion Clinical symp-toms and corresponding indicators of AECOPD patients improve after noninvasive positive-pressure ventilation,and hsCRP as well as BNP level drop subsequently,which may be attributed to the improvement of inflammatory responses and cardiac load of COPD patients by noninvasive ventilation,thus improving the prognosis of patients.