机械通气对肺部感染患者外周血B型脑钠肽水平的影响及其与患者预后的关系分析
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摘要
目的探讨无创机械通气对肺部感染患者外周血B型脑钠肽(BNP)水平的影响及其与患者预后的关系分析。方法纳入我院2015年1月至2017年4月期间收治的120例肺部感染患者为研究对象,随机分为对照组(60例)和机械通气组(60例),对照组给予常规治疗,机械通气组给予无创机械通气+常规治疗,比较两组外周血BNP水平并分析其与患者预后的关系。结果治疗72 h后,两组患者心率(HR)、呼吸频率(RR)、BNP水平均显著下降(P<0.05),两组患者动脉血氧分压(Pa O2)、动脉二氧化碳分压(PaCO_2)均显著上升(P<0.05),且机械通气组上述指标变化幅度均大于对照组(P<0.05);两组动脉血p H值均恢复正常,且无显著差异(P>0.05);机械通气组平均住院时间(12.65±3.52)d,显著短于对照组的(15.29±4.38)d(P<0.05);机械通气组存活率显著高于对照组(96.67%与86.67%,P<0.05);心功能衰竭组和死亡组BNP水平显著高于心功能正常组(P<0.05),死亡组BNP水平显著高于心力衰竭组(P<0.05)。结论无创机械通气能有效改善肺部感染患者病情,降低外周血BNP水平,改善预后,缩短住院时间和提高患者存活率,外周血BNP水平与患者预后有关,治疗中应予以监测。
Objective To investigate the influence of noninvasive mechanical ventilation on peripheral blood B-type brain natriuretic peptide( BNP) levels in patients with pulmonary infection and its relationship with prognosis.Methods A total of 120 patients with lung infection treated in our hospital from January 2015 to April 2017 were selected as study subjects,and they were randomly divided into the control group( 60 cases) and the mechanical ventilation group( 60 cases). The control group was given conventional treatment,while the mechanical ventilation group was given noninvasive mechanical ventilation combined with conventional treatment. BNP levels in peripheral blood were compared between the two groups,and the relationship between the levels and the prognosis was analyzed. Results 72 h after treatment,their heart rate( HR),respiratory rate( RR) and BNP levels decreased significantly,while the arterial partial pressure of oxygen( PaO_2) and arterial partial pressure of carbon dioxide( PaCO_2) increased significantly in the two groups( all P < 0. 05),and the changes were more pronounced in the mechanical ventilation group than in the control group( P < 0. 05). The p H value of arterial blood in the two groups returned to normal,and there was no significant difference between the two groups( P > 0. 05). The average duration of hospital stay was significantly shorter in the mechanical ventilation group[( 12. 65 ± 3. 52) d] than in the control group[( 15. 29 ± 4. 38) d]( P < 0. 05),and the survival rate of the mechanical ventilation group was significantly higher than that of the control group( 96. 67% vs86. 67%,P < 0. 05). BNP level in the heart failure group and the death group was significantly higher than those in the normal cardiac function group( P < 0. 05),and BNP level in the death group was significantly higher than that in the heart failure group( P < 0. 05). Conclusion Noninvasive mechanical ventilation can effectively improve the condition of patients with pulmonary infection,reduce the peripheral blood BNP level,improve the prognosis,shorten the duration of hospital stay and improve the survival rate. BNP level in peripheral blood is closely related with the prognosis of patients,which should be monitored during treatment.
Objective To investigate the influence of noninvasive mechanical ventilation on peripheral blood B-type brain natriuretic peptide( BNP) levels in patients with pulmonary infection and its relationship with prognosis.Methods A total of 120 patients with lung infection treated in our hospital from January 2015 to April 2017 were selected as study subjects,and they were randomly divided into the control group( 60 cases) and the mechanical ventilation group( 60 cases). The control group was given conventional treatment,while the mechanical ventilation group was given noninvasive mechanical ventilation combined with conventional treatment. BNP levels in peripheral blood were compared between the two groups,and the relationship between the levels and the prognosis was analyzed. Results 72 h after treatment,their heart rate( HR),respiratory rate( RR) and BNP levels decreased significantly,while the arterial partial pressure of oxygen( PaO_2) and arterial partial pressure of carbon dioxide( PaCO_2) increased significantly in the two groups( all P < 0. 05),and the changes were more pronounced in the mechanical ventilation group than in the control group( P < 0. 05). The p H value of arterial blood in the two groups returned to normal,and there was no significant difference between the two groups( P > 0. 05). The average duration of hospital stay was significantly shorter in the mechanical ventilation group[( 12. 65 ± 3. 52) d] than in the control group[( 15. 29 ± 4. 38) d]( P < 0. 05),and the survival rate of the mechanical ventilation group was significantly higher than that of the control group( 96. 67% vs86. 67%,P < 0. 05). BNP level in the heart failure group and the death group was significantly higher than those in the normal cardiac function group( P < 0. 05),and BNP level in the death group was significantly higher than that in the heart failure group( P < 0. 05). Conclusion Noninvasive mechanical ventilation can effectively improve the condition of patients with pulmonary infection,reduce the peripheral blood BNP level,improve the prognosis,shorten the duration of hospital stay and improve the survival rate. BNP level in peripheral blood is closely related with the prognosis of patients,which should be monitored during treatment.
引文
[1]高建平,王平,应可净.呼出气检测在肺部感染与呼吸重症中的研究进展[J].中华结核和呼吸杂志,2016,39(3):223-226.
[2]张红颖,赵若雷.80岁以上老年人肺部感染104例临床分析[J].中国基层医药,2015,22(13):2001-2003.
[3]邓屹琪,戴洁琛.急性呼吸困难患者临床特征及中医证候分析[J].中华中医药杂志,2017,32(2):848-850.
[4]陆卫红,张涛,羊镇宇,等.冠状动脉钙化积分对不稳定心绞痛患者行冠状动脉支架植入术后肌钙蛋白I和脑钠肽升高的预测作用[J].蚌埠医学院学报,2015,40(12):1658-1660,1663.
[5]张亮,吴振安,付慧哲.脑钠肽和血清肌钙蛋白I联合检测在慢性心力衰竭患者中的临床应用[J].中国临床医生杂志,2016,44(1):94-96.
[6]赵变香.机械通气下纤维支气管镜介入在重症肺部感染患者中的临床研究[J].临床医学研究与实践,2017,2(6):79-80.
[7]周冬梅,陈利,寇芳芳.老年患者医院获得性肺部感染原因分析及护理对策[J].中国消毒学杂志,2015,32(8):795-797,800.
[8]许宗磊,司明文,冯桂青,等.心力衰竭患者肺部感染血浆脑钠肽与炎性因子的变化分析[J].中华医院感染学杂志,2015,25(2):250-252.
[9]吴力,洪善贻,陈霁虹,等.参松养心胶囊和曲美他嗪治疗老年肺部感染合并心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2017,15(10):1282-1284.
[10]袁亚迎,王涛宁,任卉,等.有创与无创机械通气对急性呼吸衰竭患者临床效果及血浆脑利钠肽水平影响的比较[J].实用心脑肺血管病杂志,2017,25(1):145-147.
[11]赵斌,刘肖.无创正压通气技术在急诊的应用[J].中国医刊,2016,51(9):7-10.
[12]秦艺玮,尚观胜,付强,等.机械通气对呼吸衰竭并肺动脉高压患者BNP的影响研究[J].现代生物医学进展,2015,15(34):6766-6769.
[13]姜风琴,张学军,贺树凤,等.老年心力衰竭患者肺部感染检验指标水平变化的研究[J].中华医院感染学杂志,2016,26(3):572-574.
[14]郭书红,符孝磊,查丽黄.速效救心丸联合盐酸替罗非班氯化钠注射液治疗急性冠脉综合征患者临床疗效及对血清hs-CRP、Cys-C及BNP的影响[J].医学临床研究,2015,32(11):2191-2194.
[15]郑坤,张红.体外循环肺损伤机制与肺保护策略的研究进展[J].中国医药导报,2016,13(35):32-35.
[16]何修玉,李跃东,吴泽华,等.机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响[J].湖南师范大学学报(医学版),2015,12(1):63-65.
[17]徐非凡.有创和无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者的效果比较[J].中国医药导报,2016,13(8):128-131.
[18]易德茂,徐冬梅,唐宇.老年急性心肌梗死患者血浆BNP、hsCRP、CK-MB水平与梗死部位及预后关系分析[J].实用心脑肺血管病杂志,2015,23(4):152-155.
[2]张红颖,赵若雷.80岁以上老年人肺部感染104例临床分析[J].中国基层医药,2015,22(13):2001-2003.
[3]邓屹琪,戴洁琛.急性呼吸困难患者临床特征及中医证候分析[J].中华中医药杂志,2017,32(2):848-850.
[4]陆卫红,张涛,羊镇宇,等.冠状动脉钙化积分对不稳定心绞痛患者行冠状动脉支架植入术后肌钙蛋白I和脑钠肽升高的预测作用[J].蚌埠医学院学报,2015,40(12):1658-1660,1663.
[5]张亮,吴振安,付慧哲.脑钠肽和血清肌钙蛋白I联合检测在慢性心力衰竭患者中的临床应用[J].中国临床医生杂志,2016,44(1):94-96.
[6]赵变香.机械通气下纤维支气管镜介入在重症肺部感染患者中的临床研究[J].临床医学研究与实践,2017,2(6):79-80.
[7]周冬梅,陈利,寇芳芳.老年患者医院获得性肺部感染原因分析及护理对策[J].中国消毒学杂志,2015,32(8):795-797,800.
[8]许宗磊,司明文,冯桂青,等.心力衰竭患者肺部感染血浆脑钠肽与炎性因子的变化分析[J].中华医院感染学杂志,2015,25(2):250-252.
[9]吴力,洪善贻,陈霁虹,等.参松养心胶囊和曲美他嗪治疗老年肺部感染合并心力衰竭的疗效观察[J].中西医结合心脑血管病杂志,2017,15(10):1282-1284.
[10]袁亚迎,王涛宁,任卉,等.有创与无创机械通气对急性呼吸衰竭患者临床效果及血浆脑利钠肽水平影响的比较[J].实用心脑肺血管病杂志,2017,25(1):145-147.
[11]赵斌,刘肖.无创正压通气技术在急诊的应用[J].中国医刊,2016,51(9):7-10.
[12]秦艺玮,尚观胜,付强,等.机械通气对呼吸衰竭并肺动脉高压患者BNP的影响研究[J].现代生物医学进展,2015,15(34):6766-6769.
[13]姜风琴,张学军,贺树凤,等.老年心力衰竭患者肺部感染检验指标水平变化的研究[J].中华医院感染学杂志,2016,26(3):572-574.
[14]郭书红,符孝磊,查丽黄.速效救心丸联合盐酸替罗非班氯化钠注射液治疗急性冠脉综合征患者临床疗效及对血清hs-CRP、Cys-C及BNP的影响[J].医学临床研究,2015,32(11):2191-2194.
[15]郑坤,张红.体外循环肺损伤机制与肺保护策略的研究进展[J].中国医药导报,2016,13(35):32-35.
[16]何修玉,李跃东,吴泽华,等.机械通气对ICU肺动脉高压伴呼吸衰竭患者血浆脑钠肽水平的影响[J].湖南师范大学学报(医学版),2015,12(1):63-65.
[17]徐非凡.有创和无创正压通气治疗慢性阻塞性肺疾病急性加重期合并呼吸衰竭患者的效果比较[J].中国医药导报,2016,13(8):128-131.
[18]易德茂,徐冬梅,唐宇.老年急性心肌梗死患者血浆BNP、hsCRP、CK-MB水平与梗死部位及预后关系分析[J].实用心脑肺血管病杂志,2015,23(4):152-155.