中文摘要：

目的：观察无创正压通气（nasal intermittent positive pressure ventilation,NIPPV）对慢性阻塞性肺疾病急性加重（acute exacerbations of chronic obstructive pulmonary disease,AECOPD）合并Ⅱ型呼吸衰竭患者血浆N端脑利钠肽（N-terminal pro-brain natriuretic peptide,NT-proBNP）水平的影响并探讨其意义。方法：随机选择AECOPD合并Ⅱ型呼吸衰竭患者及慢性阻塞性肺疾病稳定期患者各40例,检测血浆NT-proBNP水平并分析其与动脉血气、APACHEⅡ评分及肺动脉压力之间的相关性;比较两组血浆NT-proBNP水平;比较NIPPV治疗前后AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP水平。结果：血浆NT-proBNP与pH值、PaO2呈负相关（分别为r=-0.691和r=-0.704,均P〈0.001）,与PaCO2或APACHEⅡ评分呈正相关（分别为r=0.774和r=0.810,均P〈0.001）,与肺动脉压力呈正相关（r=0.965,P〈0.001）;AECOPD合并Ⅱ型呼吸衰竭患者血浆NT-proBNP与pH值、PaO2呈负相关（分别为r=-0.636和r=-0.616,均P〈0.001）,与PaCO2,APACHEⅡ评分呈正相关（分别为r=0.545和r=0.475,P=0.001,P=0.002）,与肺动脉压力呈正相关（r=0.833,P〈0.001）;AECOPD合并Ⅱ型呼吸衰竭组血浆NT-proBNP明显高于慢性阻塞性肺疾病稳定期组[（939.60±250.00）pg/mL vs（151.55±111.20）pg/mL,P〈0.01];NIPPV治疗24 h后血气指标好转、APACHEⅡ评分下降,血浆NT-proBNP较治疗前下降[（229.15±98.26）pg/mL vs（939.60±250.00）pg/mL,P〈0.01];治疗后肺动脉压力较治疗前下降,但差异无统计学意义（P=0.056）。结论：血浆NT-proBNP浓度反映了AECOPD合并Ⅱ型呼吸衰竭患者病情的严重程度;NIPPV能降低该类患者的血浆NT-proBNP浓度,NT-proBNP浓度变化有助于评价NIPPV疗效。

英文摘要：

Objective：To investigate the effect of nasal intermittent positive pressure ventilation（NIPPV） on N-terminal pro-brain natriuretic peptide（NT-proBNP） in patients with acute exacerbations of chronic obstructive pulmonary disease（AECOPD） and typeⅡrespiratory failure.Methods：Forty patients with AECOPD and typeⅡ respiratory failure and 40 patients with stable phase chronic obstructive pulmonary disease were randomly assigned into study.Plasma levels of NT-proBNP,arterial blood gas,APACHEⅡ scores,and pulmonary artery pressures were measured.The plasma level of NT-proBNP was compared between the two groups.Effect of NIPPV on NT-proBNP was studied in patients with AECOPD and typeⅡrespiratory failure. Results：There were negative correlations between NT-proBNP and pH,and between NT-proBNP and PaO2（r=–0.691,r=–0.704,respectively;P0.001）,positive correlations between NT-proBNP and PaCO2,and between NT-proBNP and APACHEⅡ scores（r=0.774,r=0.810,respectively,P 0.001）,and positive correlation between NT-proBNP and PAP（r=0.965,P0.001） in all patients.In patients with AECOPD and typeⅡrespiratory failure,there were negative correlations between NT-proBNP and pH,and between NT-proBNP and PaO2（r=–0.636,r=–0.616,respectively;P0.001）;there were positive correlations between NT-proBNP and PaCO2,and between NT-proBNP and APACHEⅡ scores（r=0.545,r=0.475,respectively;P=0.001,P=0.002）;and there were positive correlation between NT-proBNP and pulmonary artery pressure（r=0.833,P0.001）.The plasma levels of NT-proBNP were significantly higher in patients with AECOPD and type Ⅱrespiratory failure than in control subjects [（939.60 ± 250.00） pg/mL vs（151.55 ± 111.20） pg/mL;P0.01].NIPPV decreased plasma levels of NT-proBNP [（229.15 ± 98.26） pg/mL vs（939.60 ± 250.00） pg/mL;P0.01] in patients with AECOPD and typeⅡrespiratory failure,as well as improved arterial blood gas and APACHEⅡscores.Although NIPPV appeared to decrease pulmonary artery pressure somewhat bet