无创正压通气对急性左心衰竭患者C反应蛋白、脑钠肽及临床疗效的影响摘要研究目的：观察无创正压通气对急性左心衰竭的治疗作用及其对C反应蛋白（CRP）和脑钠肽（BNP）水平的影响。研究方法：将急性左心衰竭患者53例分为两组：常规组27例，给予高流量吸氧+药物治疗；无创通气组26例，给予经面罩双水平无创正压通气+药物治疗。观察两组患者治疗后的临床疗效以及CRP水平的变化，此外在常规组和无创通气组各有20例患者，观察了血浆BNP水平的变化。研究结果：无创通气组有效率96.15%，常规组有效率70.37%，无创通气组的临床疗效好于常规组，差异有统计学意义（P＜0.05）。治疗后两组的收缩压（SBP）、舒张压(DBP)、心率(HR)、呼吸频率(RR)较治疗前明显降低(P<0.01)，动脉氧分压（PO2）、血氧饱和度（SaO2）较治疗前明显升高（P<0.01），治疗后1小时两组间的SBP、DBP、HR、RR、PO2、SaO2比较，差异均有统计学意义（P<0.05或0.01），治疗后24小时两组间的PO2、SaO2比较，差异有统计学意义（P<0.01）。治疗后24小时两组CRP水平较治疗前显著下降（P<0.01），两亚组的BNP水平较治疗前亦明显下降（P<0.01）。研究结论：无创正压通气在有效降低C反应蛋白和脑钠肽水平的同时提高急性左心衰竭的治疗效果。关键词：无创正压通气；急性左心衰竭；C反应蛋白；脑钠肽ABSTRACTResearchObjective:ToobservethetherapeuticeffectofnoninvasivepositivepressureventilationonpatientswithacuteleftventricularfailureandthechangesofC-reactiveprotein（CRP）,brainnatriureticpeptide（BNP）.ResearchMethods:53casesofpatientswithacuteleftheartfailureweredividedintotwogroups:conventionalgroupof27patientstreatedwithhigh-flowoxygenandroutinedrugtherapy;non-invasiveventilationgroupof26cases,givingthebi-levelnoninvasivepositivepressureventilationviafacemaskandroutinedrugtherapy.AssesstheclinicalefficacyandCRPlevelsintwogroups.Inaddition,each20patientsintheconventionalgroupandnon-invasiveventilationgroup,toobservechangesofplasmaBNPlevels.ResearchResults:Theeffectiverateofnoninvasiveventilationgroupwas96.15%,whiletheconventionalgroupwas70.37%,thedifferencewasstatisticallysignificant(P<0.05).Aftertreatment,systolicbloodpressure(SBP),diastolicbloodpressure(DBP),heartrate(HR),respiratoryrate(RR)weresignificantlylowerthanthosebeforetreatment(P<0.01),whilepartialpressureofoxygen（PO2）andoxygensaturation(SaO2)wereincreased(P<0.01).Onehouraftertreatment,therewerestatisticallysignificantdifferenceinSBP,DBP,HR,RR,PO2,SaO2betweenconventionalgroupandnon-invasiveventilationgroup(P<0.01或0.05).Twenty-fourhoursaftertreatment,therewerestatisticallysignificantdifferenceinPO2andSaO2betweentwogroups(P<0.01).Twenty-fourhoursaftertreatment,theCRPlevelsoftwogroupsweresignificantlowerthanthosebeforetreatment（P<0.01）andtheBNPlevelsoftwosubgroupswerealsosignificantlowerthanthosebeforetreatment（P<0.01）.ResearchConclusion:NoninvasivepositivepressureventilationnotonlycanreducethelevelofCRPandBNP,butalsobeabletoimprovethetherapeuticeffectofpatientswithacuteleftventricularfailure.KeyWords:Noninvasivepositivepressureventilation;Acutleftventricularfailure;C-reactiveprotein;Brainnatriureticpeptide.目录第1章引言...............................................11.1概述.................................................11.2无创机械通气的定义和发展...............21.2.1无创机械通气的定义...................21.2.2无创机械通气的发展...................21.3急性左心衰竭(ALHF)的定义和病理生理改变.........................................................21.3.1ALHF的定义....................................21.3.2ALHF的病理生理改变......................31.4无创正压...
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