心肺复苏中外周血B型钠尿肽的变化与临床意义  

Change and clinical significance of B - type natriuretic peptide in peripheral blood during cardiopulmonary resuscitation

作　　者：王金高[1] 黄继义[1] 吴伟程[1] 孔德全[1] 杨成彬[1] 潘晓文[1] 

机构地区：[1]福建医科大学附属厦门第一医院急诊部,福建厦门361003

出　　处：《中国急救医学》2009年第1期63-65,共3页Chinese Journal of Critical Care Medicine

基　　金：厦门市第一医院科研基金（No.XYK0802）

摘　　要：目的探讨外周静脉血B型钠尿肽（B-type natriuretic peptide，BNP）的动态变化与心肺复苏（CPR）患者预后的关系。方法67例心搏骤停后CPR患者，依据复苏效果分为三组，A组（33例）：CPR30min，无效死亡；B组（20例）：复苏成功，自主循环建立≥2h，但最终死亡；C组（14例）：复苏成功，存活出院；选择20例健康成年体检者作为对照组（D组）。于CPR即刻（0h）、3、6、12和24h留取静脉血，检测BNP水平，比较各组患者该指标的动态变化。结果在CPR初期，A、B、C三组BNP无明显激活，与D组比较差异无统计学意义（P〉0．05）；B组于CPR3h激活程度与C组接近，于CPR6h显著激活，较C组明显升高，差异有显著性（P〈0．05），并持续至24h；C组于CPR3h激活，6h达峰值，24h降至较低水平。结论CPR过程中，BNP的激活呈动态变化，患者CPR后出现了心功能不全。BNP的早期激活对机体可能是一种保护性反应，BNP大量持续表达可能提示CPR患者心力衰竭加重，预后不良。治疗心功能不全、提高心排血量、改善重要脏器血液灌注可能成为提高CPR成功的主要方法之一。Objective To explore the relationship between the level of B - type natriuretic peptide （ BNP} in peripheral blood and the prognosis of cardiopulmonary resuscitation （ CPR）. Methods 67 patients with sudden cardiac arrest received CPR. Patients were divided into 3 groups. The patients who didnt regain heart beats were group A（33 cases） , those who had blood circulation for over 2 hours but finally died were group B （20 cases）, and the 14 cases who survived were group C. Control group consisted of 20 healthy people with no disease. BNP was studied by BDSITE - TRIAGE. The expression of BNP ac- tivation in peripheral blood was determined at the time of 0, 3, 6, 12, 24 h after CPR in all the patients. Results The expression of BNP activation has no significant differences at the beginning of CPR in all the groups. In group C, it began to increase at 3 h, and it＇s peak was at 6 h, then decreased nearly to the nor- mal level after 24 h. No significant difference was found before 6 h between group B and C. In group B, the BNP concentration significantly increased after successful CPR, and kept high level till 24 h. Conclusions The expression of BNP activation at the initial and developing stage may indicate heart failure of CPR. At the early stage of CPR, BNP has protective effects on the body, but the massive expression of BNP activation is associated with serious heart failure of CPR, which induced high mortality of patients with CPR.

关 键 词：心搏骤停 心肺复苏(CPR) B型钠尿肽 

分 类 号：R541.7[医药卫生—心血管疾病]