NT-pro BNP水平与CVP监测对COPD机械通气患者的撤机成功率的影响
|
摘要
目的研究探讨N端脑钠肽前体(NT-pro BNP)水平与中心静脉压(CVP)监测,对慢性肺阻塞性肺疾病(COPD)机械通气患者的撤机成功率的影响。方法选取2015年1月-2017年12月在我院进行有创呼吸机辅助通气治疗的COPD患者200例为研究对象,所有患者均进行机械通气治疗,在机械通气时对患者的NT-proBNP和CVP进行监测,依据监测结果分为:观察组(n=102),即NT-proBNP≤500pg/mL,CVP≤15cmH_2O;对照组(n=98),即NT-proBNP>500pg/mL,CVP>15cmH_2O。对两组患者的撤机成功率进行统计比较,并对两组患者撤机后NT-proBNP、CVP、呼吸频率、用力肺活量等指标进行检测对比。结果 (1)两组患者性别、年龄、动脉血pH值、PaO_2、PaCO_2分压等基础资料比较差异无统计学意义(P>0.05)。(2)观察组患者撤机成功率为87.25%(89/102),对照组患者撤机成功率为68.37%(67/98),组间比较差异有统计学意义(P<0.05)。(3)观察组患者撤机后的NT-proBNP、CVP、呼吸频率均低于对照组,用力肺活量则高于对照组,组间比较差异有统计学意义(P<0.05)。结论在COPD患者机械通气治疗中通过NT-pro BNP、CVP水平进行联合监测对机械通气患者的撤机结局有一定的预测作用,可作为撤机的辅助判断指标。
Objective To investigate the effect of monitoring N terminal pro brain natriuretic peptide(NT-proBNP) level and central venous pressure(CVP) on the successful rate of mechanical ventilation in patients with chronic obstructive pulmonary disease(COPD). Methods From January 2015 to December 2017 in our hospital, 200 COPD patients received invasive mechanical ventilation were taken as the research objects. All patients were treated with mechanical ventilation, and their NT-pro BNP and CVP were monitored. According to the monitoring results, they were divided into the observation group(n=102, NT-pro BNP ≤500 pg/mL, CVP ≤15 cmH_2O) and the control group(n=98, NT-proBNP>500 pg/mL, CVP>15 cm H2 O). The success rate of weaning in the two groups was statistically compared. The indexes of NT-proBNP, CVP, respiratory rate and cardiac output were compared between the two groups after weaning. Results(1) There was no significant difference in gender, age, pH value of arterial blood, PaO_2 and PaCO_2 partial pressure between the two groups(P>0.05).(2) The success rate ofweaning in the observation group was 87. 25%(89/102),and the success rate of weaning in the control group was68. 37%(67/98)( P < 0. 05).(3) The value of NT-pro BNP,CVP and respiratory rate of the observation group were lower than those of the control group,and the cardiac output was higher than that of the control group. The difference between the two groups was statistically significant( P < 0. 05). Conclusion The combined monitoring of NT-proBNP and CVP level can predict the weaning outcome of patients with mechanical ventilation in COPD patients,which can be used as an assistant index for weaning.
Objective To investigate the effect of monitoring N terminal pro brain natriuretic peptide(NT-proBNP) level and central venous pressure(CVP) on the successful rate of mechanical ventilation in patients with chronic obstructive pulmonary disease(COPD). Methods From January 2015 to December 2017 in our hospital, 200 COPD patients received invasive mechanical ventilation were taken as the research objects. All patients were treated with mechanical ventilation, and their NT-pro BNP and CVP were monitored. According to the monitoring results, they were divided into the observation group(n=102, NT-pro BNP ≤500 pg/mL, CVP ≤15 cmH_2O) and the control group(n=98, NT-proBNP>500 pg/mL, CVP>15 cm H2 O). The success rate of weaning in the two groups was statistically compared. The indexes of NT-proBNP, CVP, respiratory rate and cardiac output were compared between the two groups after weaning. Results(1) There was no significant difference in gender, age, pH value of arterial blood, PaO_2 and PaCO_2 partial pressure between the two groups(P>0.05).(2) The success rate ofweaning in the observation group was 87. 25%(89/102),and the success rate of weaning in the control group was68. 37%(67/98)( P < 0. 05).(3) The value of NT-pro BNP,CVP and respiratory rate of the observation group were lower than those of the control group,and the cardiac output was higher than that of the control group. The difference between the two groups was statistically significant( P < 0. 05). Conclusion The combined monitoring of NT-proBNP and CVP level can predict the weaning outcome of patients with mechanical ventilation in COPD patients,which can be used as an assistant index for weaning.
引文
[1] 丁宁,王胜.慢性阻塞性肺疾病发病机制最新研究进展[J].临床肺科杂志,2016,21(1):133-136.
[2] 于秀丽,张苗,于娥,等.有创无创序贯机械通气治疗COPD的护理研究进展[J].中华现代护理杂志,2014,20(12):1482-1484.
[3] 王常永,范学朋,翁方中,等.慢性阻塞性肺疾病并呼吸衰竭患者有创机械通气撤机失败的影响因素研究[J].实用心脑肺血管病杂志,2017,25(1):46-49.
[4] WOLSK E,DEIS T,ROSSING K,et al.The significance of NT-pro BNP in patients assessed for heart transplant or LVAD[J].J Heart Lung Transplant,2018,37(4):S313-S318.
[5] 李山峰,吴璟奕,邹雅茹,等.氮末端脑钠肽前体对机械通气撤机的预测价值[J].中华急诊医学杂志,2016,25(3):334-337.
[6] DU W,SU J,YE D,et al.Pinellia ternata attenuates mucus secretion and airway inflammation after inhaled corticosteroid withdrawal in COPD rats[J].Am J Chin Med,2016,44(5):1027-1041.
[7] 袁彬凡,吴东,何若云,等.哮喘-COPD重叠综合征机械通气患者肺泡灌洗液SP-D及IL-8意义分析[J].中国免疫学杂志,2016,32(7):1035-1038.
[8] 邢柏,谭世峰,黄山,等.血浆脑钠肽水平对COPD机械通气患者撤机结局的预测价值[J].现代医学,2014,42(5):494-497.
[9] CALZETTA L,MATERA M G,BRAIDO F,et al.Withdrawal of inhaled corticosteroids in COPD:a meta-analysis[J].Pulm Pharmacol Ther,2017,45:148-158.
[10] 陈建丽,徐超,李振华.COPD合并肺动脉高压患者血清NT-proBNP和内皮素-1的表达意义研究[J].重庆医学,2016,45(23):3278-3280.
[11] 肖娟,冯健,杨克雅.益气通脉汤对冠状动脉粥样硬化性心脏病心力衰竭患者的治疗效果及对NT-proBNP水平的影响[J].中药药理与临床,2017,33(1):172-175.
[12] CHEN W C,CHEN H H,CHIANG C H,et al.Effect of salmeterol/fluticasone combination on the dynamic changes of lung mechanics in mechanically ventilated COPD patients:a prospective pilot study[J].Int J Chron Obstruct Pulmon Dis,2016,11(1):167-174.
[13] BAHLOUL M,CHTARA K,CHELLY H,et al.Acetazolamide use in severe COPD exacerbations requiring invasive mechanical ventilation:impact on duration of mechanical ventilation[J].J Thorac Dis,2016,8(5):762-764.
[14] 刘杰,王岗,孙师元.NT-proBNP联合CVP监测在机械通气患者撤机过程中的指导作用[J].临床急诊杂志,2017,18(8):622-624.
[15] GUO W,FU Y.Correlation analysis and its significance of serum NT-proBNP,pH Value and PaCO2 in patients with chronic obstructive pulmonary disease[J].West Indian Med J,2017,66(6):684-689.
[16] 崔卫正,刘爽.NT-proBNP变化对COPD机械通气患者撤机的影响研究[J].湖南中医药大学学报,2016,36(6):165-166.
[17] YU J,ZHENG R,LIN H,et al.Global end-diastolic volume index vs CVP goal-directed fluid resuscitation for COPD patients with septic shock:a randomized controlled trial[J].Am J Emerg Med,2017,35(1):101-105.
[18] 冯雪,吴岳,孟颖,等.重组人脑利钠肽对重症心力衰竭患者的疗效和安全性:一项前瞻性多中心临床研究[J].中华危重病急救医学,2017,29(6):520-524.
[2] 于秀丽,张苗,于娥,等.有创无创序贯机械通气治疗COPD的护理研究进展[J].中华现代护理杂志,2014,20(12):1482-1484.
[3] 王常永,范学朋,翁方中,等.慢性阻塞性肺疾病并呼吸衰竭患者有创机械通气撤机失败的影响因素研究[J].实用心脑肺血管病杂志,2017,25(1):46-49.
[4] WOLSK E,DEIS T,ROSSING K,et al.The significance of NT-pro BNP in patients assessed for heart transplant or LVAD[J].J Heart Lung Transplant,2018,37(4):S313-S318.
[5] 李山峰,吴璟奕,邹雅茹,等.氮末端脑钠肽前体对机械通气撤机的预测价值[J].中华急诊医学杂志,2016,25(3):334-337.
[6] DU W,SU J,YE D,et al.Pinellia ternata attenuates mucus secretion and airway inflammation after inhaled corticosteroid withdrawal in COPD rats[J].Am J Chin Med,2016,44(5):1027-1041.
[7] 袁彬凡,吴东,何若云,等.哮喘-COPD重叠综合征机械通气患者肺泡灌洗液SP-D及IL-8意义分析[J].中国免疫学杂志,2016,32(7):1035-1038.
[8] 邢柏,谭世峰,黄山,等.血浆脑钠肽水平对COPD机械通气患者撤机结局的预测价值[J].现代医学,2014,42(5):494-497.
[9] CALZETTA L,MATERA M G,BRAIDO F,et al.Withdrawal of inhaled corticosteroids in COPD:a meta-analysis[J].Pulm Pharmacol Ther,2017,45:148-158.
[10] 陈建丽,徐超,李振华.COPD合并肺动脉高压患者血清NT-proBNP和内皮素-1的表达意义研究[J].重庆医学,2016,45(23):3278-3280.
[11] 肖娟,冯健,杨克雅.益气通脉汤对冠状动脉粥样硬化性心脏病心力衰竭患者的治疗效果及对NT-proBNP水平的影响[J].中药药理与临床,2017,33(1):172-175.
[12] CHEN W C,CHEN H H,CHIANG C H,et al.Effect of salmeterol/fluticasone combination on the dynamic changes of lung mechanics in mechanically ventilated COPD patients:a prospective pilot study[J].Int J Chron Obstruct Pulmon Dis,2016,11(1):167-174.
[13] BAHLOUL M,CHTARA K,CHELLY H,et al.Acetazolamide use in severe COPD exacerbations requiring invasive mechanical ventilation:impact on duration of mechanical ventilation[J].J Thorac Dis,2016,8(5):762-764.
[14] 刘杰,王岗,孙师元.NT-proBNP联合CVP监测在机械通气患者撤机过程中的指导作用[J].临床急诊杂志,2017,18(8):622-624.
[15] GUO W,FU Y.Correlation analysis and its significance of serum NT-proBNP,pH Value and PaCO2 in patients with chronic obstructive pulmonary disease[J].West Indian Med J,2017,66(6):684-689.
[16] 崔卫正,刘爽.NT-proBNP变化对COPD机械通气患者撤机的影响研究[J].湖南中医药大学学报,2016,36(6):165-166.
[17] YU J,ZHENG R,LIN H,et al.Global end-diastolic volume index vs CVP goal-directed fluid resuscitation for COPD patients with septic shock:a randomized controlled trial[J].Am J Emerg Med,2017,35(1):101-105.
[18] 冯雪,吴岳,孟颖,等.重组人脑利钠肽对重症心力衰竭患者的疗效和安全性:一项前瞻性多中心临床研究[J].中华危重病急救医学,2017,29(6):520-524.