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无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆ANP、NTproBNP的影响
冯晓丽,黄娜,李培培,谭红梅
0
(成都医学院第一附属医院呼吸内科)
摘要:
【摘要】 目的 探讨有创无创序贯机械通气对重症肺炎合并呼吸衰竭患者血浆心钠肽(ANP)、B型氨基端利钠肽原(NTproBNP)水平的影响。方法 根据不同机械通气方法将98例重症肺炎合并呼吸衰竭患者分为序贯组(有创无创序贯机械通气)52例与常规组(传统有创机械通气)46例,比较两组治疗前后血气分析指标、呼吸频率(RR)、心率(HR)变化情况,统计两组机械通气总时间、有创通气时间、入住重症监护病房时间、总住院时间、呼吸机相关肺炎(VAP)发生率、撤机成功率及院内死亡率。另外测定比较两组患者血清相关炎症因子及心损伤相关指标。结果 两组治疗后RR、HR、二氧化碳分压(PaCO2)比治疗前均明显下降,氧分压(PaO2)、pH值明显上升,差异有统计学意义(P<005),但组间比较无明显差异(P>005);序贯组机械通气总时间、有创通气时间、入住ICU时间、总住院时间均明显短于常规组,VAP发生率、院内死亡率均显著低于常规组,撤机成功率明显高于常规组(P<005);序贯组治疗后3d血清白介素4(IL4)、白介素6(IL6)、白介素10(IL10)、肿瘤坏死因子α(TNFα)水平、血浆心钠肽(ANP)、B型氨基端利钠肽原(NTproBNP)、肌钙蛋白I(cTnI)水平均明显低于常规组(P<005)。结论 有创无创序贯机械通气治疗重症肺炎合并呼吸衰竭疗效较好,能明显缩短有创通气时间,显著降低血浆ANP、NTproBNP水平,减轻心功能损伤,同时能明显减轻机体炎症反应,减少VAP发生率及死亡率。
关键词:  有创 创序贯通气  重症肺炎  呼吸衰竭  心钠肽  B型氨基端利钠肽原
DOI:
基金项目:四川省科技厅科技支撑计划(2013SZ15357)
Effect of invasive noninvasive sequential mechanical ventilation on plasma ANP and NT proBNP in patients with severe pneumonia complicated with respiratory failure
FENG Xiaoli,HUANG Na,LI Peipei,TAN Hongmei
(Department of Respiratory Medicine, The First Affiliated Hospital of Chengdu Medical College)
Abstract:
【Abstract】 Objective To investigate the effect of invasivenoninvasive sequential mechanical ventilation on plasma atrial natriuretic peptide (ANP) and B Nterminal pro brain natriuretic peptide (NTproBNP) in patients with severe pneumonia and respiratory failure. Methods 98 patients with severe pneumonia complicated with respiratory failure were divided into the sequential group (invasivenoninvasive sequential mechanical ventilation) and the routine group (traditional invasive mechanical ventilation) according to different methods of mechanical ventilation. The changes of indexes of blood gas analysis, respiratory rate (RR) and heart rate (HR) before and after treatment were compared between the two groups. The total time of mechanical ventilation, duration of ventilation, length of intensive care unit (ICU) stay, total hospitalization time, the incidence of ventilatorassociated pneumonia (VAP), the success rate of weaning and inhospital mortality rates in two groups were statistically analyzed. After 3 days of treatment, the peripheral blood of patients was collected to determine and compare serum related inflammatory factors and cardiac injury associated indexes. Results After treatment, RR, HR and partial pressure of carbon dioxide (PaCO2) in the two groups were significantly decreased, while partial pressure of oxygen (PaO2) and pH were increased significantly (P<005). The above indexes showed no significant differences between the two groups (P>005). The total time of mechanical ventilation, duration of invasive ventilation, length of ICU stay and total hospitalization time were significantly shorter, the incidence rate of VAP and inhospital mortality rate were significantly lower, and the success rate of weaning was significantly higher in the sequential group than the routine group (P<005). 3 days after treatment, levels of serum interleukin4 (IL4), interleukin6 (IL6), interleukin10 (IL10), tumor necrosis factor α (TNFα), plasma atrial natriuretic peptide (ANP), type B Nterminal natriuretic peptide (NTproBNP) and troponin I (cTnI) were significantly lower in the sequential group than the routine group (P<005). Conclusion The therapeutic effect of sequential invasivenoninvasive mechanical ventilation is relatively better in the treatment of severe pneumonia with respiratory failure. The regimen can significantly shorten the duration of invasive ventilation and reduce the levels of ANP and NTproBNP and cardiac function injury. It also can significantly reduce the inflammatory response, the incidence of VAP and mortality rate.
Key words:  Invasive noninvasive sequential ventilation  Severe pneumonia  Respiratory failure  Atrial natriuretic peptide  Type B N terminal natriuretic peptide

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