高凯 杨钧 石榴

【摘要】 目的：探討通过观察呼气末正压通气（positive end expiratory pressure，PEEP）调控急性呼吸窘迫综合征合并心力衰竭患者N末端脑钠肽前体（NT-proBNP）表达对其临床预后及治疗机制。方法：选择2017年3月-2019年3月于本院行机械通气治疗的100例急性呼吸窘迫综合征合并心力衰竭患者作为研究对象。根据随机数字表法分为研究组（n=50）与对照组（n=50）。对照组给予常规综合治疗，研究组在常规综合治疗基础上加PEEP治疗。比较两组治疗前后呼吸频率、心率、肺顺应性、动脉血氧分压（PaO2）、血氧饱和度（SpO2）、氧合指数（PaO2/FiO2）、NT-proBNP及APACHEⅡ评分。结果：治疗72 h后，两组呼吸频率、心率、NT-proBNP及APACHEⅡ评分均低于治疗前，且研究组均明显低于对照组，差异均有统计学意义（P<0.05）;治疗72 h后，两组肺顺应性、PaO2、SpO2、PaO2/FiO2均高于治疗前，且研究组均高于对照组，差异均有统计学意义（P<0.05）。结论：急性呼吸窘迫综合征合并心力衰竭患者行呼气末正压通气可调控NT-proBNP的表达，这种作用的潜在机制可对急性呼吸窘迫综合征合并心力衰竭患者的预后进行影响。

【关键词】 急性呼吸窘迫综合征 心力衰竭 呼气末正压通气 脑钠肽

Effect of PEEP on Patients with Acute Respiratory Distress Syndrome Complicated with Heart Failure and Its Influence on NT-proBNP/GAO Kai， YANG Jun， SHI Liu. //Medical Innovation of China， 2021， 18（28）： 0-080

[Abstract] Objective： To explore the clinical prognosis and treatment mechanism of NT-proBNP through regulating its expression in patients with acute respiratory distress syndrome combined with heart failure by observing the positive end expiratory pressure （PEEP） regulating the expression of NT-proBNP. Method： A total of 100 patients with acute respiratory distress syndrome complicated with heart failure treated with mechanical ventilation in our hospital from March 2017 to March 2019 were selected as research objects. They were randomly divided into the control group （n=50） and the study group （n=50）. The control group was given routine comprehensive treatment， and on the basis of routine comprehensive treatment the study group was given PEEP treatment. The breathing frequency， heart rate， lung compliance， arterial oxygen pressure （PaO2）， blood oxygen saturation （SpO2）， oxygenation index （PaO2/FiO2）， NT-proBNP and APACHEⅡ score of two groups before and after treatment were compared. Result： After 72 h of treatment， the respiratory rate， heart rate， NT-proBNP and APACHEⅡ scores of two groups were lower than those before treatment， and the study group were significantly lower than those of the control group， the differences were statistically significant （P<0.05）. After 72 h of treatment， the lung compliance， PaO2， SpO2 and PaO2/FiO2 of two groups were higher than those before treatment， and the study group were higher than those of the control group （P<0.05）. Conclusion： Acute respiratory distress syndrome complicated with heart failure treated with positive end expiratory pressure ventilation can regulate the expression of NT-proBNP， the underlying mechanism of this effect may affect the prognosis of patients with acute respiratory distress syndrome complicated with heart failure.

[Key words] Acute respiratory distress syndrome Heart failure Positive end expiratory pressure Brain natriuretic peptide

First-author’s address： Jiangjin District Central Hospital， Chongqing 402260， China

doi：10.3969/j.issn.1674-4985.2021.28.019

急性呼吸窘迫綜合征（acute respiratory distress syndrome，ARDS）指短时间内（小于1周内），由于严重感染、创伤、休克等各种原因导致的以肺泡毛细血管损伤，临床表现为急性呼吸窘迫、顽固性低氧血症和呼吸衰竭。由美国-欧洲共识会议（AECC）于1994年定义草案并提出，并于2012年欧洲急危重症医学学会重新定义（即柏林定义）：ARDS类别基于低氧血症的程度分为轻度低氧（200 mmHg<PaO2/FIO2≤300 mmHg）、中度低氧（100 mmHg<PaO2/FIO2≤200 mmHg）和重度低氧（PaO2/FIO2≤100 mmHg），低氧血症的程度加重与死亡率增加相关[1]。……