机械通气对老年慢性肺源性心脏病患者血清脑钠肽的影响.docVIP

机械通气对老年慢性肺源性心脏病患者血清脑钠肽的影响 　　作者：梁晶，马文学，李东华 作者单位：(广东省广州市花都区人民医院内科，广州510800) 　　【摘要】 目的：探讨慢性肺源性心脏病患者在急性发作期合并呼吸衰竭时，血浆脑钠肽血清水平变化及临床意义。方法：选择慢性肺源性心脏病急性加重期，并有机械通气治疗指证60例患者，用酶联免疫吸附法测定治疗前后血清脑钠肽的水平。并与健康人40例比较 ,分析脑钠肽与动脉血氧分压 PaO2 、二氧化碳分压 PaCO2 及右室射血前期时间RVPEP /肺动脉血流加速时间 AT 的相关性。结果：肺心病患者急性加重期机械通气治疗前后脑钠肽均显著高于健康人 (P0.01 );治疗前脑钠肽明显高于治疗后 (P0.001), 机械通气治疗后脑钠肽水平降低，两者均与 PaO2 呈负相关(均P0.01) ,与 PaCO2呈正相关(均 P0.01) 。结论：机械通气治疗能降低肺心病患者脑钠肽，　脑钠肽水平能反映老年慢性肺源性心脏病患者病情的严重程度 ,短期应用机械通气 ,能降低血浆脑钠肽水平。 　　【关键词】 肺源性心脏病;脑钠肽;机械通气;酶联免疫吸附测定法 　　[Abstract] To study the effects on plasma brain natriuretic peptide(BNP) level change in the patients with chronic pulmonary heart disease received mechanical ventilation .Method: plasma BNP levels were measured by ELISA(Enzyme-Linked Immunosorbent Assay) from 60 patients with chronic pulmonary heart disease in acute stage before and after mechanical ventilation and healthy people in control ,analyzing its relationship with artery PaO2 , artery PaCO2 and RVPEP(right ventricular pre-ejection period) /acceleration time of pulmonary artery flow .Results: plasma BNP levels in patients were higher significantly than healthy people ,leave alone receiving mechanical ventilation (P0.01) ; BNP levels after mechanical ventilation were lower significantly than it before treatment(P0.001) ,both were negative correlation with PaO2(P0.01) and positive correlation with PaCO2 in contrast(P0.01). Conclusions: plasma BNP level can indicate the severity of chronic cor pulmonale in elder people and be improved by mechanical ventilation for short period . 　　[Key words] Pulmonary heart disease ; brain natriuretic peptide ; Mechanical ventilation;enzyme-linked immunosorbent assay脑钠肽是由心室肌合成和分泌的一种神经肽类激素。在心室容量和压力负荷增加时合成、分泌增加。近来很多研究表明脑钠肽在充血性心力衰竭 CHF 的诊断、鉴别诊断及评估心功能方面有重要的价值。本文旨在探讨慢性肺源性心脏病合并呼吸衰竭患者机械通气时对血浆脑钠肽血清水平影响及临床意义。 　　1 资料与方法 　　1.1 临床资料 老年慢性肺心病急性作患者60例为肺心病组 ,其中男 38例 ,女 22例;年龄 62～89岁，平均71. 50 ±10. 29岁。根据病史、体征、血气分析、X线胸片、肺功能、心电图、超声心动图结果确定诊断 ,均符合 1977年全国肺心病专业会议制定的慢性肺源性心脏病诊断标准。所有患者经