BNP在严重脓毒症合并心肌损伤的机械通气患者脱机过程中的预测作用  

The predictive effect of BNP in mechanical ventilation extubation of severe sepsis patients with cardiac insufficiency

作　　者：幸泽茂[1] 孟新科[1] 张宪华[1] 王滨[1] 周丹[1] 

机构地区：[1]广东省深圳市第二人民医院急诊ICU,广东深圳518029

出　　处：《吉林医学》2014年第25期5601-5603,共3页Jilin Medical Journal

摘　　要：目的:观察脑钠肽(BNP)在严重脓毒症合并心肌损伤患者在机械通气脱机过程中的预测作用。方法:回顾性分析急诊ICU住院严重脓毒症机械通气患者病例资料,123例患者根据首次脱机情况分为脱机成功组与脱机失败组,采用受试者工作特征(ROC)曲线分析两组患者脱机前血气分析结果及BNP水平与脱机之间的关系。结果:123例患者,一次脱机拔管成功89例,失败34例。脱机前两组动脉血氧分压(PO2)、二氧化碳分压(PCO2)及血清BNP比较:成功组PO2较失败组高,而PCO2及BNP水平则较失败组明显下降,组间比较三者差异均有统计学意义(P<0.05)。通过ROC曲线计算动脉血PO2、PCO2及血清BNP曲线下面积(AUC)分别为0.655,0.709,0.874。Youden指数最大的是BNP,其对应的脱机成功的敏感性89.89%,特异性为76.47%。结论:严重脓毒症合并心肌损伤的机械通气患者脱机过程中,BNP水平对预测拔管成功的价值较血气分析要高。Objective To evaluate the predictive effect of B-type natriuretic peptides（ BNP）in the process of extubation at severe sep-sis patients with cardiac injury. Method Retrospective analyse the extubation in severe sepsis patients with cardiac injury who need me-chanical ventilation at EICU. 123 patients were divided into success group and failed according to extubation after the first spontaneous breathe trial（ SBT）. Receive operating characteristic（ ROC）curves was used to analyses the relationship among blood gas analysis,BNP and extubation. Results There were 89 patients extubate successful after the first SBT and 34 failed. A significant difference was noted in PO2 , PCO2 and BNP between the two groups（P ﹤0. 05）. The area under the curve（AUC）of PO2,PCO2 and BNP were 0. 655,0. 709 and 0. 874,respectively. BNP had the maximum Youden index with a sensitivity of 86. 8% and specificity of 89. 89%. Conclusion The level of BNP is a more valuable predictor for extubation in severe sepsis with cardiac injury than PO2 and PCO2 .

关 键 词：脑钠肽 严重脓毒症 心肌损伤 血气分析 自主呼吸试验 

分 类 号：R459.7[医药卫生—急诊医学]