无创正压通气对慢性肺心病患者血浆降钙素基因相关肽及内皮素的影响

目的通过观察无创正压通气（NIPPV）在治疗慢性肺心病伴Ⅱ型呼吸衰竭过程中对血浆内皮素（ET）和降钙素基因相关肽（CGRP）的影响,探讨NIPPV治疗慢性肺心病呼吸衰竭的机理。方法对26例肺心病呼吸衰竭患者进行NIPPV治疗,于NIPPV治疗前和治疗后2、24 h抽血,分别用放射免疫法测定血浆ET和CGRP含量,与正常对照组对照,并将治疗前后结果进行比较。结果慢性肺心病伴Ⅱ型呼吸衰竭患者血浆ET水平明显高于健康人,CGRP水平明显低于健康人（P〈0.01）,经NIP-PV治疗后,随着通气改善,血浆ET水平下降,CGRP水平回升（P〈0.01）,治疗2 h与正常组比较已无显著差异（P〉0.05）,并且CGRP水平与PaO2呈正相关（r=0.336,P〈0.01）。结论NIPPV在改善慢性肺心病呼吸衰竭患者通气功能的同时,也使患者血浆ET降低及CGRP水平升高,提示NIPPV治疗慢性肺心病呼吸衰竭的疗效机制,可能有神经-内分泌机制参与。

Effects of non-invasive positive pressure ventilation on endothelin and calcitonin gene relative peptide in patients with cor pulmonale

Objective Through the observation of non-invasive positive pressure ventilation(NIPPV) on plasma endothelin(ET) and calcitonin gene relative peptide(CGRP) levels in patients with cor pulmonale complicated with Type 2 respiratory failure,we have investigated the mechanisms of NIPPV in the management of cor pulmonale patients complicated with respiratory failure. Methods Twenty-six patients with cor pulmonale complicated with Type 2 respiratory failure received NIPPV treatment.The plasma ET and CGRP levels were assayed with radio-immunol labeled method at the time points of 2 and 24 hours after the implication of NIPPV management,and were compared with the normal control baseline level.Results In patients with cor pulmonale complicated with Type 2 respiratory failure the plasma ET level was significantly higher than that in the normal control groups,meanwhile the plasma CGRP level was significantly lower than that in the normal control groups(P<0.01).After NIPPV treatment,the plasma level of ET decreased and CGRP increased significantly,compared to the baseline level(P<0.01).After the 2-hour treatment,the measures of the plasma ET and CGRP levels were not significantly different from the normal control baseline level(P>0.05).CGRP levels had a significant positive correlation with PaO2(r=0.336,P<0.01). Conclusion NIPPV management not only improves the ventilatory function for patients with cor pulmonale complicated with respiratory failure,but also decreases the plasma ET level and increases the plasma CGRP level.So the neuropeptide might take put in the mechanisms of NIPPV in the management of cor pulmonale patients complicated with respiratory failure.