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目的观察双水平气道正压通气(B iPAP)无创正压机械通气在治疗急性左心功能衰竭过程中对患者血浆内皮素(ET-1)、一氧化氮(NO)和脑钠肽(BNP)的影响。探讨B iPAP治疗急性心肌梗死伴急性左心功能衰竭的作用机制。方法急性心肌梗死伴急性左心功能衰竭患者33例,K illip心功能分级Ⅲ级或Ⅳ级,随机分为两组,常规治疗组(15例)给予常规治疗;无创通气组(18例)在常规治疗的基础上使用B iPAP-V ision呼吸机进行无创正压机械通气。持续治疗2周。分别于治疗前和治疗后测定血浆ET-1、NO和BNP的浓度。结果与常规治疗组比较,无创通气组患者血浆者ET-和lBNP均较治疗前有明显下降,NO水平则显著增高(P<0.01)。结论急性心肌梗死伴急性左心功能衰竭患者早期使用B iPAP呼吸机进行无创正压机械通气治疗可显著降低患者体内的ET-、lBNP水平;升高NO水平,并且能够改善心功能。
Objective To observe the changes of endothelin (ET-1), nitric oxide (NO) and brain natriuretic peptide (BNP) in patients with acute left ventricular failure during noninvasive positive airway pressure ventilation by B iPAP )Impact. To investigate the mechanism of B iPAP in the treatment of acute myocardial infarction with acute left heart failure. Methods Thirty-three patients with acute myocardial infarction complicated with acute left heart failure and K illip cardiac function grade Ⅲ or Ⅳ were randomly divided into two groups. The conventional treatment group (n = 15) was given routine treatment. The noninvasive ventilation group (n = 18) B iPAP-V ision ventilator was used for noninvasive positive pressure mechanical ventilation based on routine treatment. Continued treatment for 2 weeks. Plasma concentrations of ET-1, NO and BNP were measured before treatment and after treatment, respectively. Results Compared with the conventional treatment group, the plasma levels of ET- and lBNP in patients with noninvasive ventilation were significantly lower than those before treatment and the levels of NO were significantly increased (P <0.01). CONCLUSIONS: Early use of B iPAP ventilator for acute myocardial infarction with acute left heart failure patients can significantly decrease ET- and lBNP levels, increase NO level and improve cardiac function in patients with noninvasive positive pressure mechanical ventilation.