Effect of bilevel positive airway pressure on the level of mid-regional proadrenomedullin in patients with moderate to severe acute exacerbations of chronic obstructive pulmonary disease complicated with type Ⅱ respiratory failure
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摘要: 目的 探讨双水平正压通气(bilevel positive airway pressure，BiPAP)对中重度慢性阻塞性肺疾病急性加重(acute exacerbations of chronic obstructive pulmonary disease，AECOPD)合并Ⅱ型呼吸衰竭患者血清肾上腺髓质素前体中段肽(mid-regional proadrenomedullin，MR-proADM)水平、动脉血气分析PCO2水平及肺功能的影响。方法 选择2020年11月至2022年10月我院急诊科及ICU收治住院的中重度AECOPD伴有Ⅱ型呼吸衰竭的患者120例。根据是否使用BiPAP无创呼吸机辅助通气，分为对照组和观察组，每组60例。对照组患者不使用BiPAP无创呼吸机辅助通气(中度、重度各30例)，观察组患者使用BiPAP无创呼吸机辅助通气(中度、重度各30例)。2组分别于治疗前、治疗后3天、治疗后7天检测血清MR-proADM水平、肺功能及动脉血气，对检测结果进行比较分析。结果 观察组治疗后3天、治疗后7天血清MR-proADM水平分别为(200.88±45.98) ng/L、(124.66±34.54) ng/L，较对照组治疗后3天、治疗后7天血清MR-proADM水平[(255.42±55.56) ng/L、(191.98±47.44) ng/L)]明显降低(P＜0.05)；观察组治疗后3天、治疗后7天动脉血气分析PCO2分别为(60±11) mmHg(1 mmHg=0.133 kPa)、(44±10) mmHg，较对照组治疗后3天、治疗后7天动脉血气分析PCO2[(69±10) mmHg、(64±9) mmHg]明显降低(P＜0.05)；观察组治疗后3天、治疗后7天肺功能第1秒用力呼气容积占预计值百分比(FEV1%)水平分别为(58.63±3.85)%、(68.98±4.32)%，较对照组治疗后3天、治疗后7天肺功能FEV1%水平[(51.65±3.81)%、(56.42±3.63)%]明显升高(P＜0.05)。结论 BiPAP能显著降低中重度AECOPD合并Ⅱ型呼吸衰竭患者的血清MR-proADM水平及动脉血气分析PCO2水平，显著改善肺功能。
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关键词:
- 肾上腺髓质素前体中段肽 /
- 血气分析 /
- 肺功能 /
- 慢性阻塞性肺疾病急性加重
Abstract: Objective To investigate the effect of bilevel positive airway pressure(BiPAP) on the serum mid-regional proadrenomedullin(MR-proADM) level, arterial blood gas analysis of PCO2 level and pulmonary function in patients with moderate to severe acute exacerbations of chronic obstructive pulmonary disease(AECOPD) complicated with type Ⅱ respiratory failure.Methods A total of 120 patients with moderate to severe AECOPD accompanied by type Ⅱ respiratory failure were selected, who were admitted to the emergency department and ICU from November 2020 to October 2022. Patients were divided into a control group and an observation group based on whether BiPAP non-invasive ventilator was used for ventilation assistance, with 60 cases in each group. Patients in the control group did not use BiPAP non-invasive ventilators for assisted ventilation(30 cases in moderate and 30 cases in severe), and patients in the observation group used BiPAP non-invasive ventilators for assisted ventilation(30 cases in moderate and 30 cases in severe). The levels of serum MR-proADM, arterial blood gas and pulmonary function were measured before treatment, 3 days and 7 days after treatment in the two groups.Results The levels of serum MR-proADM in the observation group at 3 days and 7 days after treatment were(200.88±45.98) ng/L, (124.66±34.54) ng/L, respectively, which were significantly lower than those in the control group at 3 days and 7 days after treatment([255.42±55.56]ng/L, [191.98±47.44]ng/L)(P < 0.05). The levels of arterial blood gas PaCO2 in the observation group were(60±11) mmHg(1 mmHg=0.133 kPa), (44±10) mmHg, respectively, which were significantly lower than those in the control group([69±10]mmHg, [64±9]mmHg) at 3 days and 7 days after treatment(P < 0.05). The FEV1% levels in the observation group were(58.63±3.85)%, (68.98± 4.32)%, respectively, which were significantly higher than those in the control group([51.65±3.81]%, [56.42±3.63]%) at 3 days and 7 days after treatment(P < 0.05).Conclusion BiPAP could significantly decrease the levels of serum MR-proADM and arterial blood gas analysis of PaCO2 in patients with moderate to severe AECOPD complicated with type Ⅱ respiratory failure, and improve the pulmonary function. -
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表 1 2组患者治疗前、治疗后3天、治疗后7天血清MR-proADM水平比较
ng/L，X±S 组别 例数 治疗前 治疗后3天 治疗后7天 对照组 60 303.38±58.74 255.42±55.561) 191.98±47.441) 观察组 60 308.12±51.46 200.88±45.981)2) 124.66±34.541)2) t 0.099 14.200 32.700 P >0.05 ＜0.05 ＜0.05 与同组治疗前比较，1)P＜0.05；与对照组同时点比较，2)P＜0.05。 
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表 2 2组患者治疗前、治疗后3天、治疗后7天动脉血气分析pH、PO2、PCO2、肺功能FEV1%水平比较
X±S 组别 pH PO2/mmHg PCO2/mmHg FEV1/% 对照组(60例) 治疗前 7.01±0.13 52±11 86±8 43.52±3.65 治疗后3天 7.33±0.111) 81±101) 69±101) 51.65±3.811) 治疗后7天 7.34±0.101) 81±111) 64±91) 56.42±3.631) 观察组(60例) 治疗前 7.02±0.13 49±12 88±9 43.52±3.28 治疗后3天 7.34±0.111) 72±101) 60±111)2) 58.63±3.851)2) 治疗后7天 7.34±0.101) 84±111) 44±101)2) 68.98±4.321)2) 与同组治疗前比较，1)P＜0.05；与对照组同时点比较，2)P＜0.05。
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