36例血浆脑钠肽含量与容量负荷关系探讨  

Discussion on relationship between plasma brain natriuretic peptide and blood volume loading

作　　者：沈亚伟[1] 罗晓明[2] 周亮[2] 

机构地区：[1]安徽医科大学第四附属医院ICU,合肥市230000 [2]安徽医科大学第一附属医院ICU,合肥市230022

出　　处：《中华全科医学》2014年第12期1897-1899,共3页Chinese Journal of General Practice

基　　金：安徽医科大学校基金资助项目(2012xkj094)

摘　　要：目的通过探讨PICCO监测下胸腔内血容量指数与脑钠肽(BNP)的相互关系及干扰BNP的相关因素,找出能够准确反映容量负荷的标志物,从而应用于临床辅助ICU医生判断患者容量负荷。方法选取ICU患者36例,利用脉搏指示连续心输出量监测系统(PICCO)记录胸腔内血容量指数(ITBVI)、全心舒张末容积指数(GEDVI)、血管外肺水(EVLWI)等血流动力学指标,在进行液体管理前后测定BNP血浆含量,与相应的血流动力学指标比较,通过相关性分析探讨两者关系,并分层研究干扰BNP反映血容量的相关因素。结果 36位患者BNP血浆含量与对应的ITBVI无显著相关性(r=0.22,P=0.194),但ΔBNP(2次BNP血浆含量差值)与对应的ΔITBVI(2次ITBVI差值)存在显著相关性(r=0.58,P=0.000)。非机械通气状态下BNP血浆含量与对应的ITBVI则存在显著相关性(r=0.52,P=0.003)。年龄、APACHEⅡ、HR、ΔSVRI与ΔBNP无显著相关性。ΔGEDVI、ΔEVLWI、ΔSVI、ΔCFI、ΔCVP与ΔBNP存在显著相关性。结论 BNP可反映患者容量负荷,连续监测BNP血浆含量的变化将更能准确反映容量负荷状态。Objective To explore the relationship between plasma brain natriuretic peptide（BNP） and intrathoracic blood volume index（ITBVI） under PiCCO monitoring system, and factors related to BNP, and to find the markers which can ac- curately reflect the blood volume to therapy in clinic. Methods 36 critically ill patients requiring hemodynamic monito- ring（ PiCCO monitoring system） were prospectively enrolled. The hemodynamic variables （ITBVI, GEDVI and EVLWI） were measured simultaneously with blood sampling for BNP level. The correlations between changes in BNP and changes in ITBVI were tested using pairwise correlation analysis. Results BNP level was not correlated with GEDVI. But BNP level was significant correlated with GEDVI in the patients with no mechanical ventilation. The changes in BNP（ABNP） showed significant correlation with changes in GEDVI（AGEDVI）. Variables including Age, APACHE Ⅱ , HR and ASVRI was not correlated with ABNP. Other variables such as AGEDVI, AEVLWI, ASVI, ACFI and ACVP were significantly cor- related with ABNP. Conclusion BNP levels can indicate the blood volume loading, and continuous measurements of BNP levels may be an accurately tool for monitoring volume status.

关 键 词：脑钠肽 胸腔内血容量指数 容量负荷 

分 类 号：R540.49[医药卫生—心血管疾病] R446.112[医药卫生—内科学]