氮末端-前脑钠肽对严重脓毒症患者心功能评估意义及乌司他丁干预的临床研究  

Evaluation of N-terminal pro-B-type natriuretic peptide for cardiac function in patient with severe sepsis and clinic research of ulinastatin

作　　者：陶杨[1] 马渝[2] 周发春[1] 

机构地区：[1]重庆医科大学附属第一医院ICU,重庆400016 [2]重庆市急救医疗中心ICU,重庆400014

出　　处：《重庆医科大学学报》2011年第12期1468-1471,共4页Journal of Chongqing Medical University

基　　金：重庆市卫生局资助项目(编号:2008-2-271)

摘　　要：目的:观察氮末端-前脑钠肽(N-terminal pro-B-type natriuretic peptide,Nt-proBNP)与左室射血分数(Left ventricularejection fraction,LVEF)的相关关系,探讨Nt-proBNP对严重脓毒症患者早期心功能障碍的预测价值及乌司他丁对脓毒症性心功能障碍的干预效应。方法:收集2009年6月至2010年12月期间我院中心ICU收治的严重脓毒症患者资料40例,随机分为对照组(C组)和乌司他丁治疗组(U组),C组在确诊严重脓毒症后接受早期目标导向治疗,U组在接受上述治疗同时给予乌司他丁干预,用法为30万IU静脉滴注,每天2次,连续5 d后减为10万IU每天2次,连用2 d;2组患者分别于治疗前、治疗后第4天、第7天3个时间点采血测定Nt-proBNP,同时行床旁超声心动图检查测量LVEF。结果:2组患者Nt-proBNP水平均于治疗后第4天达峰值,至治疗后第7天明显下降,U组峰值低于C组(P<0.05),2组治疗后第7天Nt-proBNP水平均低于治疗前,U组差异有统计学意义(P<0.05),而C组差异无统计学意义(P>0.05);2组患者LVEF值均于治疗后第4天降至最低值,C组较U组降低更明显,至治疗后第7天明显回升,U组回升显著(P<0.05),2组治疗后第7天LVEF值均高于治疗前,U组差异有统计学意义(P<0.05),而C组差异无统计学意义(P>0.05);所有入选患者按LVEF值分组,LVEF≤50%组Nt-proBNP水平明显高于LVEF>50%组(P<0.05);2组患者各时间点Nt-proBNP与LVEF均负相关(P<0.05)。结论:Nt-proBNP与LVEF负相关,可作为预测严重脓毒症患者早期心功能障碍的指标之一;乌司他丁干预治疗能明显降低Nt-proBNP水平,改善严重脓毒症患者心功能。Objective：To investigate the correlation between N-terminal pro-B-type natriuretic peptide（Nt-proBNP） and left ventricular ejection fraction（LVEF）,determine the predictive value in severe sepsis patients with early myocardial dysfunction,and identify the intervention effect of ulinastatin in sepsis induced myocardial dysfunction.Methods：Forty severe sepsis patients were randomly divided into control group（Group C） and ulinastatin group（Group U）,with 20 patients in each group.Group C accepted early goal directed therapy,and Group U accepted additional therapy of ulinastatin intravenous drop,300,000 units each time,and two times a day for 5 days;then reduced to 100,000 units each time,and two times a day for 2 days.Concentration of plasma Nt-pro BNP and left ventricular ejection fraction were measured at pre-therapy,on the 4th day and the 7th day.Results：Concentration of plasma Nt-pro BNP reached its peak on the 4th day,which was lower in Group U than in Group C,then reduced on the 7th day,which was lower than that at pre-therapy in the two groups,but the difference had statistical significance only in Group U（P0.05）.The level of LVEF was the lowest on the 4th day in the two groups,which was lower in Group C than in Group U;then it increased on the 7th day,and was higher in group U（P0.05）.All patients were divided into two groups according to LVEF.LVEF50% meant normal cardial function,and otherwise meant abnormal.Concentration of plasma Nt-pro BNP was higher in abnormal group（P0.05）.There was negative correlation between Nt-pro BNP and LVEF.Conclusion：Concentration of Nt-proBNP is negatively correlated with LVEF.It may be used to prognose myocardial function in patients with severe sepsis.Ulinastatin can reduce the concentration of Nt-proBNP and improve myocardial function of severe sepsis patients.

关 键 词：脑钠肽 脓毒症 左室射血分数 乌司他丁 

分 类 号：R541[医药卫生—心血管疾病]