急性失代偿心力衰竭者利尿前后QRS综合波增幅与脑钠肽的变化  

The Relationship between augmentation of QRS Complex wave amplitude and serum level of brain natriuretic peptide in patients with acute decompensation of chronic heart failure before and after diuresis therapy

作　　者：齐心欣[1] 洪华山[2] 

机构地区：[1]福建医科大学附属协和医院,福州350001 [2]福建省福州市第二医院,350007

出　　处：《实用心电学杂志》2010年第6期403-407,共5页Journal of Practical Electrocardiology

基　　金：福建医科大学附属协和医院重点学科基金资助项目(2005113)

摘　　要：目的探讨急性失代偿性心衰利尿前后QRS综合波幅值(∑QRSWA)的动态变化和∑QRSWA变化与脑钠肽(BNP)浓度变化的关系。方法测量30例急性失代偿心衰患者利尿前、后12导联的∑QRSWA(12∑QRSWA)、导联Ⅰ+Ⅱ的∑QRSWA(2∑QRSWA)及肢体6导联的∑QRSWA(6∑QRSWA);记录利尿后尿量;测定利尿前后BNP-32浓度、Na+、Cl-、白蛋白、肌酐、血红蛋白及红细胞压积。结果 12∑QRSWA,2∑QRSWA,6∑QRSWA在利尿后第3d,第6d,第9d为154.0±55.0mm,169.7±62.5mm,179.6±65.7mm;16.7±7.5mm,17.8±7.4mm,19.9±8.1mm;44.1±19.5mm,49.7±20.4mm,55.1±24.5mm分别高于治疗前水平(136.4±56.4mm,14.7±7.3mm,33.9±18.4mm)(P<0.01)。第9d血清BNP-32的水平明显低于治疗前的水平(102.7±47.2pg/mlvs2647.9±1951.4pg/ml)(P<0.01)。治疗后第6d较第3d12∑QRSWA、2∑QRSWA及6∑QRSWA的增加值分别与第2个3d尿量较第1个3d尿量的增加值间呈正相关(r=0.514,P<0.01;r=0.463,P=0.01;r=0.504,P<0.01)。治疗后第9d较治疗前12∑QRSWA、2∑QRSWA及6∑QRSWA的增加值分别与血清BNP-32浓度的减少值间呈负相关(r=-0.497,P<0.01;r=-0.435,P<0.05;r=-0.472,P<0.01)。结论Δ∑QRSWA不但可作为评价急性失代偿心衰患者利尿治疗疗效的简单可靠的指标,而且可能作为反映心衰患者利尿治疗后心功能改善的指标。Objective To assess the effect of diuresis-based fluid loss on patients treated for acute decompensation of chronic heart failure(ADHF)on QRS complex wave amplitude(∑QRSWA)and the correlation of augmentation of ∑QRSWA and serum level of brain natriuretic peptide(BNP).Methods Thirty patients with ADHF received diuresis.∑QRSWA from 12 leads(12∑QRSWA),from leads Ⅰ+Ⅱ(2∑QRSWA),from 6-limb leads(6∑QRSWA)were calculated before diuresis and after treatment respectively.The amount of urine after treatment was recorded respectively.BNP-32 before diuresis and after treatment was measured with enzyme-linked immunosorbent assay(ELISA).Serum sodium,chlorine,albumin,creatinine,hemoglobin,hematocrit before diuresis and after treatment were also measured respectively.Results 12∑QRSWA,2∑QRSWA and 6∑QRSWA after treatment in the third day,the sixth day and the ninth day were 154.0±55.0mm,169.7±62.5mm,179.6±65.7mm;16.7±7.5mm,17.8±7.4mm,19.9±8.1mm;44.1±19.5mm,49.7±20.4mm,55.1±24.5mm,which were significantly higher than 12∑QRSWA,2∑QRSWA and 6∑QRSWA before diuresis respectively(136.4±56.4mm,14.7±7.3mm,33.9±18.4mm)(P<0.01).Serum BNP-32 level after treatment in the ninth day was significantly lower than before diuresis(102.7±47.2pg/ml vs 2647.9±1951.4pg/ml)(P<0.01).Augmentation of 12∑QRSWA,2∑QRSWA and 6∑QRSWA after treatment on the sixth day versus the third day correlated positively with increasing of the amount of urine after treatment in the second 3 days versus the first 3 days respectively(r=0.514,P<0.01;r=0.463,P=0.01;r=0.504,P<0.01).Augmentation of 12∑QRSWA,2∑QRSWA and 6∑QRSWA after treatment on the ninth day versus before diuresis correlated negatively with decreasing of serum BNP-32 level after treatment on the ninth day versus before diuresis respectively(r=-0.497,P<0.01;r=-0.435,P<0.05;r=-0.472,P<0.01).Conclusion Augmentation of ∑QRSWA in ADHF patients after diuresis can be used as an easily obtainable and reliable index of both the fluid loss and heart function improvemen

关 键 词：失代偿性 心力衰竭 利尿治疗 QRS综合波 脑钠肽 chronic heart failure brain NATRIURETIC peptide level wave QRS Complex 心衰患者 增加值 浓度变化 尿量 导联 BNP 心功能改善 红细胞压积 治疗疗效 指标 

分 类 号：R54[医药卫生—心血管疾病]