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1、L浆BNP水平在老年COPD患者呼吸机脱机中评估中图分类号：R562；R563.8文献标识码：A文章编号：1009_816X(2011)04_0267—03D0I：10.3969/j.issn.1009_816X.2011.04.06TheEvaluationofBrainNatriureticpeptideduringWeaninginElderlyPatientswithChronicObstructivePulmonaryDisease.XUQiang_hong,YANJing,GONGShi_jin,etal.DepartmentofInten
2、siveCareUnit,ZhejiangHospital,Zhejiang310012,China[Abstract]ObjectiveToevaluatetheutilityofserialmeasuremeritsofplasmabrainnatriureticpeptide(BNP)bydetectingacutecardiacdysfunctionduringweaningfailureforelderlypatientswithchronicobstructivepulmonarydiseaseindifficulttowean.Metho
3、ds60elderlypatientswithchronicobstructivepulmonarydiseaseweredividedintotwogroups：BNPapplicationgroup(30cases)andstandardtherapygroup(30cases).Cardiacandhemodynamicvariables,arterialbioodgas,respiratorymechanicsandindexesofoxygencostofbreathing,weremeasuredandanalyzedimmediately
4、before(baseline)andattheendofaspontaneousbreathingtrial.PlasmalevelsofBNPandeachmeasurementofBNPaftereveryhourwasmeasuredinapplicationBNPgroup.BNPwasmeasuredinApplicationBNPgroupandaccordingtoBNPvalue,patientsweredividedintotwogroups：normalgroupandincreasedgroup；Beforeandafterwe
5、aning,LVEFwasmeasuredbyechocardiographys.ResultsComparedwithstandardtherapygroup,HRSBPDBPSa02RRPa02/Fi02PH,PaC02,Pa02ofthepatientswithincreasedBNPvalueinBNPapplicationgroup,increasedsignificantlyafterSBT(P<0.05)；Comparedwithnormalgroup,HRSBPDBPSa02RRPa02/Fi02PH,PaC02,Pa02ofthepa
6、tientswithincreasedBNPvalueinBNPapplicationgroupincreasedsignificantly(P<0.05).InBNPapplicationgroup,patientswhoweanedsuccessfullyweremorethanthestandardtherapygroup.ConclusionsSerialmeasurementsofBNPplasmalevelsprovideanoninvasivemannertodetectacutecardiacdysfunctionduringanuns
7、uccessfulweaningtrialfortheelderlypatientsindifficulttoweanwithchronicobstructivepulmonarydiseaseindifficulttowean.TheuseofBNPcanimprovethesuccessrateofweaningoutcome.[Keywords]BNP；ChronicObstructivePulmonaryDisease；Weaning；theElderly接受机械通气的慢性阻塞性肺病（COPD）急性加重患者常常存在脱机困难［1］。呼吸力学加重和
8、所产生的呼吸肌疲劳、肺动脉嵌压升高、急性左心室缺血、左心室射血分数下降和右心室扩大伴随室间隔左
