N-末端脑钠肽前体对感染性休克患者早期容量复苏及预后的意义  

Prediction of N - terminal pro brain natriureflc peptide in the early volume resuscitation andprognosis of patients with septic shock

作　　者：商娜[1] 张源波[2] 周荣斌[2] 王新华[2] 杨萌[2] 崔北辰[2] 吕苏[2] 

机构地区：[1]安徽医科大学研究生院,安徽合肥230032 [2]北京军区总医院急诊科,北京100700

出　　处：《中国急救医学》2013年第2期111-113,共3页Chinese Journal of Critical Care Medicine

摘　　要：目的探讨N一末端脑钠肽前体（NT—proBNP）在感染性休克患者早期容量复苏中的预测价值及对预后的意义。方法对30例感染性休克患者给予早期目标指导性治疗（EGDT），记录复苏后脉搏连续心输出量监护仪（PiCCO）监测下的全心舒张末期容积指数（GEDVI）、胸腔内血容量指数（ITBVI）、血管外肺水指数（EVLWI）、心脏指数（cI）及NT—proBNP浓度，并行急性生理和慢性健康状况评分Ⅱ（APACHE1I），比较NT—proBNP与上述指标的相关性。分析存活组（23例）与死亡组（7例）NT—proBNP浓度和APACHElI评分。结果所有患者经EGDT后GEDVI、ITBVI、CI、NT—proBNP均升高，EVLWI无明显变化。NT—proBNP浓度与CI（r=0．664，P〈0．05）、GEDVI（r=0．629，P〈0．05）呈正相关，与EVLWI无相关性。死亡组APACHEll评分、NT—proBNP浓度均明显高于存活组（P〈0．05）。结论NT—proBNP对感染性休克患者早期容量复苏及预后有预测价值。Objective To explore the predictive value of N - terminal pro brain natriuretic peptide（NT- proBNP） in the early volume resuscitation and prognosis of patients with septic shock. Methods Thirty patients with septic shock were included in the present study. All were given early goal- directed therapy after diagnosis. NT - proBNP was measured at the bedside. To assess the correlation between NT - proBNP and cardiac preload, we also detected global end - diastolic volume index（GEDVI） and intrathorac blood volume index （ITBVI） which can reflect cardiac preload. Extravascular lung water index （EVLWI） was also measured to observe the risk of pulmonary edema. Record all the indicators above once the completion of EGDT six hours later. Moreover, make analysis of differences in NT - proBNP and APACHE II between survivors and deaths. Results Blood levels of NT- proBNP and hemodynamic indicators such as GEDVI, ITBVI and CI increased significantly. Notably, the increase of NT - proBNP levels was associated with that of GEDVI （ r = 0. 629, P 〈 0.05 ） and CI（r =0.664, P 〈 0. 05 ）, but with no correlation with EVLWI. The levels of NT- proBNP and APACHE 11 in deaths were significantly higher than survivors. Conclusion NT- proBNP may be a good predictor of cardiac preload in early volume resuscitation therapy, and of great value in prognosis in patients with septic shock.

关 键 词：N-末端脑钠肽前体(NT—proBNP) 心脏指数(CI) 全心舒张末期容积指数(GEDVI) 早期目标指导性治疗(EGDT) 急性生理和慢性健康状况评分Ⅱ(APACHEII) 

分 类 号：R631.4[医药卫生—外科学]